HomeMy WebLinkAbout25-6499 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG16651oc� RA
COLLISION REPORT 1591971
CASE# 25-6499 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY. 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 07 - 28 - 2025 1844 17 =.= S 8 W E IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
NE 9TH ST BLOCK NO. e 900 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 . FEET S 8 W e ABERDEEN AV NE
OF 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:6302093889 0 1 30
6 LAST NAME TIAN FIRST NAME TIM MIDDLE 1 1 2 31
INITIAL
STREET ❑ 2700 WILLIAMS AV N CITY RENTON ST WA ZIP 98056 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NOR] INTERLOCKYEs NO�/ YES F No,/
8❑ LCEENSE# STATE WA SEX M MMDCSYY' 05 — 03 — 1962 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS ? NAruRE of INJURIES 2
LICENSE, C34506V STATE WA VN# 3TMDZ5BN7LM095381 3
10[9� PI ATP rt
11[-j— TRAILER STATE TRAILER ,STATE ROM TO
11 2 5 PLATE# PLATE#
TRLR TRLR 7 1 33
12 2 5 VIN# VIN
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2020 TOYT TACOM DAMAGE YES�No ✓� YES❑ 1 5 34
REGISTERED OWNER INFO TIM TIAN 2700 WILLIAMS AVE N RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 ALLSTATE 817621298
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ sTANowc 7 e
MOTOR PEDAL YES 1/ NO PHONE
UNIT PEDESTRIAN PROPERTY D:42 VEHICLE CYCLE52007603 nWNFR
16�
LAST NAME RODRIGUEZHERNANDEZ FIRST NAME GUILLERMO MIDDLE I N
INITIAL
17 F1 STREET ❑❑ ?335162ND LN NE APT E CITY 37 BELLEVUE ST, WA ZIP 980083522
NEW AbbRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTEDi 38
INTERLOCKYEs ND INTERLOCK YESf—I NO YEs NC
19[ DRIVER'S STATE WA SEY M I E.O.B. 02 10 1973 ❑ 39
LICENSE# MMDDYY —
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ? ❑
21[ LICENSLATE E BQW8234 rarE WA vIN# USE
41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2002 MAKE HOND MODEL CIVICSTYLE SD VEHICLE TOWED 70 BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO GUILLERMO RODRIGUEZHERNANDEZ 1335162ND LN NE APT E BELLEVUE WA 98008 VEHICLE NO,2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCECO WAINSA102274412
IN EFFECT &POLICY# 9TOP
`HiaE ❑ CITATION11 CHARGE t08OTTOM
LEGAlL,v YES N J
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG16651
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6499
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} RODRIGUEZ HERNANDEZ EDUARDO N
(LAST,FIRST
ADDRESS&PHONE# DOB
16168 NE 11TH ST BELLEVUE WA 980083527 SEX' M MMDDYYYY 10 - 13 - 1981
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Q 2 POS. ' 3 12 4 1 USE CLASS ;1 �_ --�
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -F L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----�
NARRATIVE
Unit 1 traveling eastbound on NE 9th turning left onto Aberdeen Av NE. Unit 2 traveling southbound
on Aberdeen Av NE approaching NE 9th St. The collision involved an uncontrolled intersection with
no signals or stop signs. Unit 1 collides with Unit 2 causing reportable non disabling front end
damage to both units. No injuries reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 07-29-25 12:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 81612025 8:09:12 PM
BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:48 PM TIME POLICE ARRIVED 6:51 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG 16651 CASE# 25-6499 DATE AND TIME 07/28/25 18:44
OF COLLISION
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