HomeMy WebLinkAbout25-7972 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG28978OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE# 25-7972 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 6 0 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E IN eDLLISION' 09 - 13 - 2025 0313 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD N BLOCK NO. e 100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1.� FEET e S 8 W e BRONSONWAYN
0 3 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2062271014 0 4 30
5 LAST NAME NGUYEN FIRST NAME KIRBY MIDDLE H 1 1 2 31
INITIAL
STREET ] 815 LYNNWOOD AVE NE CITY; RENTON ST WA ZIP; 98056 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES No✓ INTERLOCKYEs NO✓ YEs NO✓
8 DRIVE E# STATE SEX M MMDDY
0,13. 11 - 24 - 2003 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSINJURY 1 F !!E of INJURIES 2
LICENSE, CGJ2296 STATE WA V 5YJ3E1EA2JF164231 3
10� PI ATP tt
STATE STATE
TRAILER TRAILER
11 0 0 PLATE# PLATE# FROM To
TRLR TRLR 3 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2018 MAKE TESL MODEL 3 STYLE SD V Y EHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 1
13� DAMAGE YES II_II NO ✓ YESII_] N 34O✓
REGISTERED OWNER INFO KIRBY NGUYEN 815 LYNNWOOD AVE NE RENTON WA 98056 D:2062271014 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
8 LIABILITY INSURANCE INSURANCE CO 4
14 GE/CO 4311693750
IN EFFECT &POLICY# 9TOP
VEn" CHARGE 5 I < 36
LEc LT YES❑NO❑ CITATION# t a 80TTOM
15❑ STM ING 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2062933050
16�
LAST NAME KADUSHIN FIRST NAME CLAYTON MIDDLE
INITIAL
17 F1 STREET ❑
❑ 5147 S LED ST CITY SEATTLE ST, WA ZIP 98175 37
NEW ADDRESS
18❑ CDL IGNITION REGtUJRED IGNITION PRESENT MEDICAL TRANS'PORTED'. 38
INTERLOCKYES NO✓ INTERLOCK YES no✓ YES NO✓
19� DRIVER'S STATE WA SEXIM I D.O.B. 03 29 1986 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSLATE E C60078S rare WA vIN# 3GNFK12317G141691 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2007 MAKE CHEV MODEL AVALANC STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYER vEs No✓
REGISTERED OWNER INFO CLAYTON KADUSHIN 5147 S LED ST SEATTLE WA 98175 D:2062933050 VEHICLE NO.2
SHADFY DAGAREA
LIABILITY INSURANCE INSURANCECO AMERICAN FAMILY 41054767273
IN EFFECT &POLICY# 9TOP
V—L ,J—I CITATION# CHARGE t080TTOM
LEGnLY YES❑ N`[
25 a ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
NICHOLAS SWAN 12965 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG28978
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7972
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) CARTER CURTIZ
ADDRESS&PHONE#
9111 191ST ST E PUYALLUP WA 98375 SEXi M MMDDD B. 06 - 10 - 2003
SEAT HELMET I INJURY INATURE CFINJURIES
PASSENGER z WITNESS0 UNIT# 1 2 POS. 3 AIRBAG j 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 7 COMPLAINT OF NECK PAIN
:NAME
(LAST EIRST,MIDDLE INITIAL) SHUM HANLEY
ADDRESS R PHONE#
562 GRAHAM AVE NE RENTON WA 98059 SEX' MMDD Y M D.O.B.YYY 11 - 28 _ 1991
SEAT HELMET INJURY NATURE CFINJURIES
PASSENGER a WITNESS UNIT# 2 POS. ' 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----�
:NAME
(L4ST FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURECFINJURIES
POS. I USE CLASS
NARRATIVE
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NICHOLAS SWAN 09-15-25 01:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 911712025 11:09:01 PM
BADGE OR ID# 12965 ORI# WA0171300 TIME POLICE DISPATCHED 3:13 AM TIME POLICE ARRIVED i 3:13 AM
PAST B 3 Do-3mx-attar gt 1Mfft PAGE 2�OF 4
REPORT NO.` EG28978 CASE# 25-7972 DATE OF COLLI r�510NN + 09/13/25 03:13
L1
NARRATIVE
#25-7972
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 09/13/2025 at approximately 0313 hours I responded to a blocking collision at Sunset Blvd N and
Maple Valley Hwy in the city of Renton, King County, WA.
Unit#1 was a blue 2018 Tesla Model 3 with WA LIC: CGJ2296 (VIN: 5YJ3E1 EA2JF164231) and was
only occupied by a driver.
Unit#2 was a burgundy 2007 Chevrolet Avalanche with WA LIC: C60078S (VIN:
3GNFK12317G141691). Unit 2 had a front passenger and a rear passenger.
Both drivers and vehicular occupants stated they were wearing their seatbelts and that they were
okay. The front seat passenger in unit 2 complained of neck pain. This passenger also had felony
warrants and was taken into custody where he was transported to Valley Medical Center by another
Renton Police Officer and medically cleared before booking.
Driver 1 of Unit 1 stated he was traveling westbound on Maple Valley Hwy and turning north onto
Sunset Blvd N. He stated he had a green light and as he went through the light, he struck the side of
Unit 2.
Driver 2 of Unit 2, stated he was traveling eastbound on Bronson Way N and turning north on to
Sunset Blvd N. He stated he had a green light that turned yellow as he approached and went through
the intersection. As he turned into lane 1 on Sunset Blvd N he felt Unit 1 strike his vehicle in the front
passenger wheel well.
Unit 1 was able to be driven away by the owner.
Unit 2 was unable to be driven from the scene and was towed at the owners expense.
I took pictures of the vehicles and uploaded them to Axon Evidence.
An exchange of information was provided to both drivers. Each of them had motor vehicle insurance.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 not confirming that it was safe and clear to turn right on to Sunset Blvd N.
If the driver of Unit 1 would have confirmed there was no oncoming traffic, then this collision would
not have occurred.
This concludes my report.
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 N. Swan #12965 on 9/13/2025 at 2039 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EG28978 CASE# 25-7972 DATE AND TIME 09/13/2503:13
OF COLLISION
(i y
}
r �{
y
e
i
yp, ti
h r,
i
PAGE 4 OF 4