HomeMy WebLinkAbout25-8444 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-8444 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 09 - 1-— 2025 1358 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❑ 150 00 FMILES NEET ❑ S ❑ E ❑ DUVALL AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2062284583 0 11
30
6� LAST NAME GERENSE FIRSTNAME MSGINA MIDDLE 1 2 31
INITIAL
STREET 01 7127 38TH AVE S CITY SEATTLE ST WA 2jp, 981186406 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICIENSE# STATE yyq SEX'M I ELMM DAY' 12 — 30 — 1972 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
❑10 9❑ Pi ATE 14 CLX3227 sTAr WWAv N# 3FAHPOHG8AR209056 3
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7
13 34
4 D OW FORD FUSION DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO SOFIA YI 10122NDAVEAPT2 SEATTLEWA98122 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP 5
VEH CHARGE 10 BOTTOM 36
LEGALLY YEs❑NO CITATION# 5A0005698,5A0005698, OP MOT VEH W/OUT INSURANCE,FL
15❑ NDING 8 7 6
1.� MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑ D:4259028807
VEHICLE CYCLE '. OWNER YES NO �/
16 a
LAST NAME HUGHES FIRST NAME RYAN MIDDLE M
INITIAL
17 STREET I❑ 5❑' 14504 209TH AVE SE CITY RENTON ST WA ZIP 980598946 4❑ 37
NEW ADORE5
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 10 _ 2007 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLATE# CGS4135 TArE WA vIN1 1HGCM66565A038231 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2005 MAKE HOND MODEL ACCORD STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JENNIFER HUGHES 14504209TH AVE SE RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE I PORGY#E CO GARRISON PROP AND CAS INS CO 050243776R71027 1UQ,
5IN EFFECTVEHICLe ❑ ,.II CITATION# CHARGELEGALLY YES N25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG40690
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8444
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'
On 09-29-2025 at about 1358 hours, I was sent to a collision which occurred in the 4700 block of NE
4th St, with in the City of Renton, King County, Washington.
Upon arrival I spoke with both drivers, and they had the same account of the collision.
I was informed that unit 1 was headed eastbound in the 4700 block of NE 4th St in the double left turn
lane making a left turn into a private driveway. Unit 2 was headed westbound in lane 1 in the 4700
block of NE 4th St. Unit 1 turned in front of unit 2 and unit 2 collided with unit 1.
There was not reportable damage but the driver of unit 1 did not have insurance.
Both drivers were identified via their WADL.
I cited the driver of unit 1 for no insurance, expired registration more than 2 months, and vehicle
turning left.
The driver of unit 1 did not have insurance when requested.
His vehicle registration for his car with WA plates CLX3227 expired on 05-15-2025 which is more
than 2 months.
He also made a left turn from the double left turn lane in front of unit 2 not yielding which was a
contributing factor in the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 09-30-25 06:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 1012312025 9:05:24 AM
BADGE OR ID# 10065 OR]# WA0171300 TIME POLICE DISPATCHED 1:58 Pry TIME POLICE ARRIVED 2:25 PM
PART I PAGE IT]OF 3�
REPORT NO. EG40690 CASE# ' 25-8444 DATE AND TIME 09/29/25 13:58
OF COLLISION
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