HomeMy WebLinkAbout25-9744 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG47142oc� RA
COLLISION REPORT 1591971
CASE# 25-9744 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 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
eDL�ISION' 11 - 09 - 2025 1418 17 =.= S 8 W E INOF 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK NO. e 200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00-] MILES N
FEET e✓ S 8 E e LAKE AVE S
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4254783033 0 1 30
5 LAST NAME JEWETT FIRST NAME LINDSAY MIDDLE K 1 1 2 31
INITIAL
STREET ❑ 710 240TH WAY SE UNIT A304 CITY; SAMMAMISH ST WA ZIP 98074 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDIQAL TRANSPORTED 3
INTERLOCK YEs No✓ INTERLOCICVEs No✓ YES No P
8❑ DRIVER # STATE WA SEXI F MMDDYY' 07 - 13 - 1986 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
3
10� pjC,q�S�', BQH8217 STATE WA yIN# 5FNRL5H62C6140349
TRAILER STATE TRAILER STATE FROM To 11 2 5 PLATE# PLATE#
TRLR TRLR 3 7 33
12 2 5 VIN#' vIN#
FROM TO
VEH.YEAR 2012 MAKE yOND MODEL ODYSSE STYLE VN VEHICLE TOWED[n TO ZBUN TOWED BY GOVT VEHICLE 3 7 34
13 DAMAGE YES I_II NO ✓ YESII_I) NO✓
REGISTERED OWNER INFO LINDSAY JEWETT 7f0240TH WAY SE UNIT A304 SAMMAMISH WA 98074 D:4254783033 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILITY INSURANCE NSURANCE CO USAA USAA 0122241857107
IN EFFECT &POLICY#VEHICLE 4TOP _
YES
srgNOLNG ❑ ❑ SA0897644 CHARGE IMPROPER LANE USAGE o ooTrofi 36
NO CITATION#
15
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2063078213
16�
LAST NAME HOANG FIRST NAME VIET MIDDLE q
INITIAL
17 F1 STREET ❑
❑ 20322 102ND AVE SE CITY KENT ST, WA ZIP 98031 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYEs No✓ INTERLOCK YES No✓ vEs No✓
19 DRIVE #
INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSECDW7819 TATE I WA VIN# 5J8YE1H41NLO33226 41
22❑ [TILER TAILER PLATE# STATE PLATE# STATE E 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE A CUR MODEL MDX STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24� DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO VIETHOANG20322102ND AVE SE KENT WA 98031 D:2063078213 VEHICLE NO.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCE CO STATE FARM 230 7617-F07.47D
IN EFFECT &POLICY# 9TOP
wae CHARGE
L'vEeGnLY YES❑ NL] to BOTTOM
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG47142
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9744
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) LUONG HIEN N
ADDRESS&PHONE# D O
20322 102ND AVE SE KENT WA 98031 2064889681 SEXi F MMDDYYYY 12 — 25 — 1989
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 3 2 4 1 USE CLASS 1 ---�
:NAME
(LAST EIFS7 MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
Unit 1 westbound on S 2nd St, lane 3 of 4. Unit 2 westbound on S 2nd St, lane 2 of 4. Unit 1 changed
lanes to the left, into lane 2. Unit 1 left front corner struck right rear quarter panel and right rear wheel
of unit 2. Driver 1 Jewett told me that she was attempting to change to the far left lane, after her GPS
navigation directed her into the 200 S 3rd St parking lot. Jewett told me that she didn't see unit 2 at all
prior to the collision. Driver 2 Hoang told me that he saw unit 1 standing in lane three as he
approached, before unit 1 abruptly changed lanes to the left and into passing unit 2. Jewett issued
NOI for improper lane change via complaint.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 11-09-25 03:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 11/1112025 3:46:36 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:20 PM TIME POLICE ARRIVED i 2:24 PM
PAST B 3 Da-3mx—attar gt 1Mffp PAGE 2�OF F3
REPORT NO. EG47142 CASE# 25-9744 DATE AND TIME 11/09/25 14:18
OF COLLISION
w l
1
may'
4
t �
t }y P
s
Y` r
t}
ya,
a
H� 4L lY
x
R }w�
y
l
P
l
l.� 4
14
PAGE 3 OF 3