HomeMy WebLinkAbout25-8871 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-8871 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.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#
cowsloN 10 - 1-- 2025 1708 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ❑ FEET e S ❑ w 3RD PL S
❑
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2064273331 0 11
30
6 LAST NAME KHUU FIRST NAME MINH TAM MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 4414 S BENEFIT ST CITY SEATTLE ST WA 2jp, 98118 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� ANK2130 sTArI WAurN# 2HKYF18566H557174
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 HOND PILOT UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO TRAVELERS 6174467282031 3 4
IN EFFECT &POLICY# 9TOP
VE"'C' CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES,/ NO D:2064729882
16 a
LAST NAME GARCIA FIRST NAME DARIO MIDDLE B
INITIAL
17 STREET NEW ADDREs7 600 SW 5TH CT APT H103 CITY RENTON ST WA ZIP 98057 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 D IVERI #
❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ LICENSE I PLA E# BXH3625 TArE WA VIN# 1HGCS1B87AA016161 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH YEAR 2010 MAKE HOND MODEL ACCORD STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO,� 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE864109791IN 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG39000
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8871
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NGUYEN CELINA
(LAST FIRST,
ADDRESS&PHONE#
4414 S BENEFIT ST SEATTLE WA 98118 SEXi F MMDOYyvv 06 - 04 - 2006
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. 3 1 4 1 USE 2 CLASS !1
NAME
(LAST,FIRST,MIDDLE INITIAL) GARCIA AMOR
ADDRESS&PHONE# D O B
RENTON WA SEX U MMDovvvv 10 _ 08 _ 1978
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 1 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. 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.
KEITH PETTY 10-13-25 06:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1 1011912025 2:03:07 AM
BADGE OR ID# 1Y809 OR]# WA0171300 TIME POLICE DISPATCHED 5:10 PM TIME POLICE ARRIVED',5:12 PM
PART I PAGE IT]OF 4�
REPORT NO. EG39000 CASE# 25-8871 OF COLLISION
10/13/25 17:08
OF CbLLI510N
NARRATIVE
25-8871
On 10/13/2025 at approximately 1712 hours, I was dispatched to Fred Meyer located 485 Renton
Center Way SW in the City of Renton, County of King, State of Washington for a non-injury non-
blocking accident.
Upon arrival I confirmed there were no injuries with either party.
Unit 1 was a silver 2006 Honda Pilot (ANK2130/WA) VIN 2HKYF18566H557174, driven by the
registered owner Minh-Tam Thi Khuu (DOB 01/02/1974)
Unit 2 was a silver 2010 Honda Accord (BXH3625/WA) VIN/1 HGCS1 B87AA016161, driven by the
registered owner Dario B Garcia (DOB 06/13/1978. All parties were identified by their WADL.
Unit 1 was heading south on Rainier Ave S. Unit 1 had a red light at S 3rd PI and attempted to make
a right-hand turn into the Fred Meyer parking lot. Unit 2 was heading west crossing the Rainier Ave S/
S 3rd PI intersection when unit 1 made a right-hand turn colliding into the passenger side of unit 2.
The damage exceeded $1000.
Unit 1 stated that she did not see unit 2 when she made the turn.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 10/13/25t 1829 hours, Place: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EG39000 CASE# ' 25-8871 DATE AND TIME 10/13/25 17:08
OF COLLISION
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PAGE 4 OF 4