HomeMy WebLinkAbout25-8940 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG40769 170
27
COLLISION REP FIT 1591971
SASE 25-8940 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
cawsloN 10 - 1-- 2025 1609 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ �.❑ FEET e S ❑ VV e W/L!IAMS AVE N
0 4 29
MOTUNIT O1 VEHICR PI PEDAL-CLE CYCLE ElYYESA�NO THRESHOLD MET PHONE O 11
30
6� LAST NAME PROVENT FIRSTNAME DAMIEN MIDDLE 1 1 2 31
INITIAL
STREET ❑ 7215 S LANGSTON RD CITY SEATTLE ST WA ZIP 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
❑ DRIVER'S' STATE PE SEXI M MD-O B 09 1- 24 - 1991 2 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
U EET IINIJAU RY NA
1 TURE OF INJURIES z❑
3
LICENSE CSH4937 STATE WA VIN# KMHL34JJOSA104094
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FRom ro
TRLR. YRLR. 3 5 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 3 ] 34
13 1 2025 HYUN SONATA DAMAGE vesNo � �MEYER ves❑ No
REGISTERED OWNER INFO HERTZ VEHICLES LLC 18625 DES MOINES MEMORIAL DR SEATAC WA 98148 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME SELF/HERTZ 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLDMET PHONE
�Ul
NIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066973146
16 a
LAST NAME KWONG FIRST NAME YUEN INDOLE T
NITIAL
17❑ STREET ❑', 9037 46TH AVE S CITY SEATTLE ST WA ZIP 981185001 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.Q.B. 09 _ 05 _ 1997 0 39
LICENSE# MMDDYY
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CBL2004 TATe WA vIN1t JTDL9MFU2N3035147
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2022 MAKE TOYT MODEL PRIUSLE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO YUEN KWONG 903746TH AVE S SEATTLEWA98118 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE� &POINSULICY#E CO SAME. IGQI
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG40769
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8940
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'
gry both u2 lane 4 u1 It from lane 3
RTF
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of N
4th St at Williams Ave N.
I contacted the driver of unit 2 who told me she was westbound in lane 4 when unit struck her car
from the passenger side. She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his French drivers license. He told me he was in lane 3 and
wanted to turn left from N 4th St to SB Williams Ave S and did not see unit 2 striking her vehicle in the
passenger side of her vehicle. He did not complain of injury and damages required a tow for her
Hertz Rental vehicle.
Information/Insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 10-17-2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 10-17-25 09:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 10/23/2025 1:39:06 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 4:09 Pry] TIME POLICE ARRIVED',4:20 PM
PART I PAGE IT]OF 3�
REPORT NO. EG40769 CASE# 25-8940 DATE AND TIME 10/15/2516:09
OF COLLISION
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