HomeMy WebLinkAbout25-3307 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-3307 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION' 04 - 1-- 2025 1858 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 3200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e NE 13TH ST
2 0 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2065718751 1 2 30
6 LAST NAME SION GUEX FIRST NAME SERGIO MIDDLE E 1 1 2 31
INITIAL
STREET ❑, 3716 NE 14TH ST CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CMA6452 STATE WA uN# JHLRD78494CO30004
10 9❑ Pr ATE 1e
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR $ 1 33
12 3 5 VIN#' VIN#
ROM TO
VEH.YEAR 2004 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 1 34
13 4 HOND CR-V DAMAGE YES NO YES[:] ✓
REGISTERED OWNER INFO DOSE CDR MARlOQUIN 3716 NE 14TH ST RENTON WA 98056 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
EGHALLY YES❑NO❑ CITATION# 5AO115841 NO VALID OPER LICENSE WITH o aorrom
15❑ STANDING 7 6
MOTOR PEDAL pROpERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4255454560
VEHICLE CYCLE OWNER YES NO �/
16 a
LAST NAME ENGRAHM FIRST NAME BRENDAN MIDDLE I T
INITIAL
17❑ STREET ❑', 650 DUVALL AVE NE APT F624 CITY RENTON ST WA ZIP 980595759 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs❑NOF YES❑NOF,/
19 DRIVERS#
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BOB9775 TATe WA vIN# 1G6DG5E54C0132300
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2012 MAKE CADI MODEL CTS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO BRENDAN ENGRAHM 7311 COAL CREEK PKWY SE APT H NEWCASTLE WA 98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGESSIVE 986783590IN 1GQI
"'LE ❑ ,.I— CITATION# CHARGE
LEGALLY YES N`LJ
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF85824
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3307
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 heading north, technically eastbound along the 3200 block of NE Sunset Blvd. Unit 2 facing
north, technically east within the center turn lane along the 3200 block of NE Sunset Blvd. Unit 2
merges into the left lane of travel as Unit 1 changes lanes from right to left. Unit 2 fails to yield right of
way when merging into traffic causing minor non reportable non disabling front passenger side
damage to Unit 2 and non reportable non disabling driver side damage to Unit 1. No injuries. Unit 1
driver cited for NVOL w/lD and no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 04-12-25 07:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 4/25/2025 5:47:33 PM
BADGE OR ID# ! 12651 ORI# WA0171300 TIME POLICE DISPATCHED 7:02 Pry TIME POLICE ARRIVED',7:04 PM
PART I PAGE IT]OF 3�
REPORT NO. EF85824 CASE# ' 25-3307 DATE AND TIME 04/12/25 18:58
OF COLLISION
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