HomeMy WebLinkAbout25-4318 POLICE TRAM 27iTFFiNc
"i ,one COLLISION REP F 1591971
CASE# 25-4318 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 2 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75#OF02 STRUCK TOTAL OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 05 - 15 - 2025 2115 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NONINTERSECTION ❑
N3RD BLOCK 8 1600 .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ FEET e S e W 8 SUNSET BVLD N
OF 4 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YEs NG �/ D:4254307400 0 4 30
6� LAST NAME ROSEN FIRST NAME RYAN MIDDLE' R 1 1 2 31
INITIAL
STREET E:1 13211 32ND AVE S CITY TUKWILA WA
NEW ADDRESS S7 ZIP 981683065 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 3
zERLOCK YEs No,/ INTERLOCK Yes No
8❑ LDICENS STATE WA SEX'M MM flYY 03 - 06 - 1983 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET CLASS 1 NATURE OF INJURIES 2
10 1❑ PUCnNS#',, 66282D STATE WA WIN# 1FVACXFC2KHKJ7791 3
11 3 0 PLATE# STATE PLATE# STATE FROM To
TRLR TRLR. 3 5 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR 2011 MAKE ELGN MODEL M2 STYLE SS VEHICLE TOWED fj TO BLIN TOWED BY GOVT.VEHICLE 3 5 34
13 DAMAGE YES NO ✓ YES❑ NO
REGISTERED OWNER INFO CITY OF RENTON 3555 NE 2ND ST RENTON WA 98056 �/EH6SAM ED 1 ❑
SHADE 1N DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 CITY OF RENTON SELF INSURED
IN EFFECT &POLICY# 4TOP _
VtwCLL CHARGE i 5 ❑ 36
EGALl v YES[:]NO[:] CITATION# 10 ftOTTOM
15❑ --NyG a 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' ❑ ❑ OWNER YES NO D:2537541537
16�
LAST NAME ANTONIO FIRST NAME FREDERICO MIDDLE M
INITIAL
17❑ STREET El 3118 S 140TH ST CITY TUKWILA ST', WA ZIP 981686004 37
NEW ADDRESS ❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
W7ERLOCKvEs No INTERLOCK Es N- YES No,�
19 F DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N U MEET INJURY
NJCLA S 1 NATURE of INJURIES 40
21❑ LICENSE I CPV6822 TATf'WA vIN# 3FA6POLU2LR212462
❑ 41
PLATE#
TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42
23 43
TRLR RLR
VIN#. 'IN#,
VEH.YEAR 2020 MAKE FORD MODEL FUSION STYLE DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
O
24 YES
REGISTERED OWNER INFO FREDERICO ANTON102302025TH AVE SAPT 220 DES MOINES WA 98198 VEHICLE NO.2
SHADE..J,p!DAMAGED AREA
LIABILITY INSURANCE INSURANCE CO NATL GEN 2027251939 4� 3 4
IN EFFECT &POLICY# t 4TOP 5
—1-1 ❑ .1-1 CITATION# CHARGE tOBOTTQM
L-ALLY YES N`'L J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF91861
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4318
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
Units 1 and 2 both in their respective left turn lanes, facing westbound on N 3rd St at the intersection
of Sunset Blvd N. Both units awaiting green light at intersection. Upon signal change, Unit 1 makes a
wide left turn on the outside rightmost lane but undercuts turn. Unit 2 also makes left in the middle
turn lane. Unit 1 strikes Unit 2 causing non reportable non disabling damage to Unit 1's driver side
sweeper head and reportable non disabling front passenger bumper and quarter panel damage to
Unit 2. No injuries. It appears that the proximate cause of collision was Unit 1 taking the turn too
shallow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 05-15-25 10:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 511612025 12:50:18 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 9:18 pry/ TIME POLICE ARRIVED i 9:25 PM
PART B 3000-345.160(R1Vt8) PAGE 0 OF F3
REPORT NO. EF91861 CASE# 25-4318 DATE AND TIME 05/15/25 21:15
OF COLLISION
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