HomeMy WebLinkAbout25-8560 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 25-8560 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 10 - 1-— 2025 2155 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET ❑ S ❑ W❑ DUVAL!AVE NE
0 4 29
UNIT MOTOOR ❑ CYDDAL ❑ DYESA✓NOESHOLDMET PHONE 0 1 30
6� LAST NAME GUEYE FIRSTNAME MODOU MIDDLE F 1 2 31
INITIAL
STREET ❑, 2119 DUVALL AVE NE C(Ty RENTON ST WA 2jp, 980593639 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 01 1— 04 — 2005 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3❑10 1❑ P1 ATE 14 CP60501 STATE WA u N# JTDKB20U763155394
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' UIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 2006 TOYT PRIUS P4 DAMAGE YES NO YES❑ NO✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 IN EF IT INSURANCE BRISTOL WEST G01586740301
IN EFFECT &POLICY# Q
veBI LECHARGE 5 36
LECALLv YES❑NO❑ CITATION# 5A0319258 FAIL YIELD LEFT TURN MOTOR 5
15❑ STANDING 6
1.� MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑
VEHICLE CYCLE OWNER YES 1/ NO
16 a
LAST NAME VO FIRST NAME NGHIA MIDDLE I T
INITIAL
17 STREET I❑ s❑' 5238 NE 3RD PL CITY' RENTON ST WA ZIP 980595058 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19 LDI IVERI # STATE WA SEX M M .C... 11 01 1970 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# AFW4890 TATE WA vIN 41
# STDZA23C75S228989 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2005 MAKE 7'Oy7' MODEL SIENNA STYLE VN DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 4134664D2147BIN STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N
' a
7m-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
FERNANDES 12848 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EG35369
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8560
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Vehicle 1 was driving eastbound on NE 4TH ST and approached the intersection of NE 4TH ST and
Duvall AVE NE. Driver 1 stated that the traffic signal was flashing yellow, and he made a left hand
(northbound) turn onto Duvall AVE NE. Vehicle 1 collided with vehicle 2 in the intersection, as vehicle
2 was driving westbound on NE 4TH ST. Driver 2 said that the light was green as he entered the
intersection and was struck by vehicle 1. There were no injuries, both vehicles were privately
impounded, and driver 1 was issued a traffic citation for RCW 46.61.185.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MARIA FERNANDES 10-03-25 12:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
HANSEN HSU 12651 1 10/7/2025 5:58:25 PM
BADGE OR ID# 1Y848 ORI#; 'i WA0171300 TIME POLICE DISPATCHED 9:88 PM TIME POLICE ARRIVED',10:01 PM
PART I PAGE IT]OF 3�
REPORT NO. EG35369 CASE# 25-8560 DATE AND TIME 10/02/25 21:55
OF COLLISION
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