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HomeMy WebLinkAbout25-4320 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF98479OLCERA COLLISION REPORT 1591971 CASE# 25-4320 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCALANG 4250 3 C©DINGCOUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s o v' 05 - 15 - 2025 2200 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ UNION AV NE BLOCK NO. e 1300 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 1.1 FEET e S 8 W e NE SUNSET BLVD 0 1 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4258915715 0 8 30 6 LAST NAME UNK FIRST NAME MIDDLE t 1 2 31 INITIAL STREET ❑' UNK CITY', RENTON NEW ADDRESS ST 2 ZIP: 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTER LOCK YES NO✓ INTERLOCKY Na✓ YES NO;✓ 8❑ LCEENSE# SRVERSTTATE SEX M MMDDYY' -�- 1 2 32 9� ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT 9 N U EET 9 LA SY p UNKRE OF INJURIES 2= LICENSE, CLX8144 STATE WA V # 4S4BP86C364318065 3 10� as ATP rt TRAILER STATE TRAILER STATE 11 0 0 PLATE# I I PLATE# I FROM To TRLR zRLR. 1 5 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR 2006 MAKE SUBA MODEL LEGACY STYLE SD VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34 13 DAMAGE YES ✓ YES NO✓ REGISTERED OWNER INFO PIERRE YOUNG 14041145TH AVE SE RENTON WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ NSURANCE CO NONE 3 4 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE 5 36 Lemur YES[:]NO[:] CITATION# i o 80TTOM 15❑ sTnNowc s 7 e MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ nWNRR D:2064273413 16� LAST NAME DICKINSON FIRST NAME CLAUDIA MIDDLE M 17 F1 INITIAL STREET ❑ 4511 NE 24TH ST CITY'.. RENTON ST, yyq ZIP 98059 37 NEW ADDRESS❑ 18❑ CDL IGNITION REt]UIRED IGNITION PRESENT MEDICAL TRANSPORTEDI ❑ 38 INTERLOCKYEs NO✓ INTERLOCK YES R No✓ YES NO✓ 19 DRIVER'S MMDDYY — HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENS BMP1365 rare WA vIN# 4T1BD1FK5GU182210 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2016 MAKE TOYT MODEL CgrylRy STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO CLAUDIA DICKINSON 4511 NE 24TH ST RENTON WA 98059 VEHICLE NO.2 SHADE IN DAMAGE,�,AREA 2 3 �4 LIABILITY INSURANCE❑ INSURANCE CO NONE IN EFFECT &POLICY# 9TOP vewcLE ,.I—I CITATION# CHARGE to BOTTOM L'EGILY YESZ N 25 a s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF98479 COLLISION REPORT III III III III III 111 1591972 CASE# 25-4320 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES POS. ' USE GLASS 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 CIASS ----� :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 Unit 1 and Unit 2 southbound on Union Av NE at intersection of NE Sunset Blvd. Unit 2 rear ended by Unit 1 as Unit 2 was stopped at signal at intersection. Unit 2 sustains non reportable non disabling scratch/scuff damage to the rear passenger side bumper. Unit 1 unknown non disabling damage to front end. Unit 1 driver reportedly supplied Unit 2 driver with first name and phone number of Jerome and 4258915715 and a partial WA Driver license number of which did not return with a positive record. Neither Units had proof of vehicle 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 05-24-25 12:38 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY I DATE P.SUMMERS 8887 1 6/6/2025 8:46:23 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 10:09 PM TIME POLICE ARRIVED i 10:35 PM PAST B a Da-3mx-attar(txIMR) PAGE 2�OF F3 REPORT NO. EF98479 CASE# 25-4320 DATE AND TIME 05/15/25 22:00 OF COLLISION r t y>e s s ,� nr w,. a Y a r V• PAGE 3 OF 3