HomeMy WebLinkAbout25-2743 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF77877 170
27
COLLISION REP FIT 1591971
CASE 25-2743 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 04 STRUCK' FENCE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 03 - 1-- 2025 0656 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE 168TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e 125THAVE SE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES NO D:2532660611 0 11
30
6 LAST NAME DO FIRSTNAME TONY MIDDLE I V 1 1 2 31
INITIAL
STREET ❑ 17402 125TH AVE SE CITY RENTON ST WA 21p 980586139 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
,OF
Pi ATNES# BTD6473 sTAr WAv N# JTDP4RCE3LJ047312
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 $ 34
13 2 2020 TOYT COROL DAMAGE YES NOBS YES[:] No✓
REGISTERED OWNER INFO NANCYDO 17402125THAVE SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
❑ ❑ INSURANCE CO 2 3 4
14 INLIABILITYEFFECT INSURANCE SAME.
IN EFFECT &POLICY# � 9TOP
VEH" CHARGE 36
LEGALLY YES❑NO❑ CITATION# 5A0333551 FAIL YIELD LEFT TURN MOTOR Io aorrom
15❑ STANDING
MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
YE
UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ S 1/ NO
16 a
LAST NAME SAYAMOUNGKHOUNM FIRST NAME AYDEN MIDDLE /
INITIAL
17❑ STREET ❑', 11701 SE 165TH ST CITY' RENTON ST WA ZIP 980585349 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA SEX M D.Q.B. 09 _ 21 2008 0 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C664617 TAre WA vIN# WBANV93588CZ61102
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE BMW MODEL 535 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO HUAN LAM 1317 W BONNEVILLE ST MOSES LAKE WA 98837 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF77877
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2743
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FAULAFO CHRIST
(LAST FIRST,
ADDRESS&PHONE#
5038888229 SEX i U MMDDYYYY 09 - 20 - 1976
--------------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-27-25 03:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 312812025 2:48:59 PM
BADGE OR ID# 2517 ORI#' WA0171300 TIME POLICE DISPATCHED 6:57 AM TIME POLICE ARRIVED]7:03 AM
PART I PAGE IT]OF 5�
REPORT NO. EF77877 CASE# 25-2743 OF COLLISION
03/27/25 06:56
OF CbLLI510N
NARRATIVE
blk/1 It from 125 hit wht/2 eb unit 1 hit chain link unit 2 hit street sign and wood fence
CC
Within the city limits of Renton/King/WA I responded to a 2 vehicle crash at the intersection of SE
168th St at 125th Ave SE.
I contacted the driver of unit 2 who told me he was eastbound on SE 168th St when unit 1 pulled out
in front of him with no chance to avoid contact. Unit 2 post impact struck a cautionary/crosswalk sign
knocking it out of the concrete sidewalk. He came to rest with the driver side of his car up against a
wood fence of a resident. He did not complain of injury and damages did require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was making a left turn from
northbound 125th Ave SE when he pulled directly across the path of unit 2. He was contacted just
behind the driver seal of his vehicle. His vehicle spun out of control, went partway up a residents
front yard and chain link fence. The same resident of the damage wood fence by unit 2. He did not
complain of injury and damages did require a tow truck. He told me he made an improper turn
causing the crash.
I contacted the home owner who had her fence damaged both front and back yard. She was
provided a copy of the information exchange for insurance purposes.
I contacted the City of Renton Sign Dept and provided them the location of the downed sign and
Renton Police case number for insurance purposes.
I cited unit 1 ref RCW 46.61.185 FTYROW-Left Turn 2 car cash and property damage via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 3/27/2025
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EF77877
r`) POLICE TRAFFIC 1 27
COLLISION REPORT CASE# 25-2743
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO
D:4255234657
MIDDLE.. 29
LAST NAME RUIZ FIRST NAME KUANYIN INITIAL
STREET _—] H 30
NEW AnnRFSP' 16752 125TH AVE SE CITY RENTON ST WA ZIP 98057
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YEs No zERLOCK YES E]Na� YEs N
L
DRIVER'S STATE SEX F M�DDYBYv 07 - 11 - 1956
LICENSE
7 F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
F�
USE CLASS
8 ❑ ' 1 32
LICENSE+ rar V1N.#
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO. m 33
12 SHADE IN DAMAGED AREA
FROM TO
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# tGQ
VEHICLE 34
13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE
STANDING 4 MOT{7R PEDAL PROPERTY a 7 e
DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES✓ NO D:4254307400
36
15 ❑ LAST NAME RENTON FIRST NAME CITY OF MIDDLE
INITIAL
16 ❑ STREET ❑! 3555 NE 2ND ST CITY! RENTON ST WA ZIP 98056
NEW AnnRFS.9
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTEL
17 ❑ INTERLOCK YES No INTERLOCK YEs NO YEs NO
DRIVER'S STATE SEX U D.O.B El37
18 ❑ LICENSE# MMDDYYY
ON DUTY STATUS AIRBAG RESTR, EJECT HELMET INJURY' NATURE oF1NJURIES ❑ 38
USE (CLASS
19 ❑ 39
LICENSE rnr vIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LecALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-27-25 03:01 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 2517 O#I',WA0171300 APPROVED BY
3/28/2025 PAGE F OF 5
3000-345-013(R 11118)
REPORT NO. EF77877 CASE# 25-2743 DATE AND TIME 03/27/25 06:56
OF COLLISION
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PAGE 5 OF 5