HomeMy WebLinkAbout25-4492 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF98962oc� RA
COLLISION REPORT 1591971
CASE# 25-4492 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCODIGENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
TRIBAL UNITS 01 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 05 - 22 - 2025 1526 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
SE 128TH ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e 156TH AVE SE
0 3 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE
❑ CYCLE ❑ YES No ,� D:2062909069 30
5 LAST NAME VIAN FIRST NAME JOHN MIDDLE L 1 1 2 31
INITIAL
STREET ] 1301 N 36TH ST CITY; RENTON I ST WA ZIP; 98056 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCK YEs NO Z/ INTERLOCKYEs Na�/ YES F NO�/
8❑ DCIENSE# STATE WA SE XI M MMDDYY' 02 - 17 - 1959 t 32
9 ON DUTY STATUS' AIRBAG 1 RESTR 13 EJECT 3 HELMET 7 IN
6 NATURE of INJURIES 2
USE ,CLASS RIGHT KNEE AND ANKLE PAIN.
10 LI ENSE'' JB4485 STATE WA VIN# 1HD1GDV103K338319 3
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM To
TRLR rRLR. 3 1 33
12 VIN#' VIN#
FROM TO
VEH.YEAR 2003 MAKE HD MODEL FXDL STYLE MC VEHICLE TOWED fn TO ZBLIN TOWEDBY GOVT VEHICLE m 34
13 DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE[%/]F INSURANCE CO PROGRESS/VE 13028116 4
IN EFFECT &POLICY# 9TOP
vE E CHARGE t 5 36
LecnLLr YES[:]NO[:] CITATION# t a 80TFOM
15❑ STMDING s 7 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT 02 � � PEDESTRIAN
VEHICLE CYCLE' OWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY ST ZIP 4❑ 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED 38
INTERLOCKYEs NO INTERLOCK YES R No vEs NQ
19 DRIVER'S
# STATE SEX MMDDYY 39
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASSLICENSE
❑
21 PLATE# T-1- VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
vewaE ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES N`0
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
LACY SMITH 12613 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF98962
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4492
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 NJURY NATURE OF INJURIES
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
On 05/22/2025, 1 was assigned to District 22 as the, 1 R22. At approximately 1529 hours I was
dispatched to an injury accident located at SE 128TH ST/156TH AVE SE. This incident occurred in
the City of Renton, County of King, State of Washington.
Upon my arrival, Renton Fire was already on scene and was providing first aid. 1 contacted and
positively identified the driver of WA/1 B4485 as, John Lyle Vian, via his Washington State Drivers'
license.
Vian stated that he was traveling EB on SE128th St and braked to make a right turn onto SE 156th
Ave SE. When Vian braked his motorcycle tipped over and he hit his right knee on the pavement.
Vian complained of pain to his right knee and ankle. At this time Vian was having a difficult time
standing. Vian's wife was called to the scene to transport him to receive medical treatment.
The bike was moved to Renton's Fire Station located at 12923 156th Ave SE.
There was a small amount of damage to the right side of the motorcycle.
Vian was not cited for this collision.
During this incident, 1 was equipped with a body-worn camera, which records both audio and video.
Portions of this incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer L. Smith 12613 on 05/22/2025 in Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
LACY SMITH 05-22-25 04:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
T NELSON 12327 61412025 6:40:28 PM
BADGE OR ID# 12613 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:29 PM TIME POLICE ARRIVED i 3:33 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. E F98962 CASE# 25-4492 DATE AND TIME 05/22/25 15:26
OF COLLISION
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