HomeMy WebLinkAbout25-9723 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG48300OLCERA
COLLISION REPORT 1591971
CASE# 25-9723 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOL`CODICENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 6 0 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 11 - 08 - 2025 1953 17 =.= S 8 W e IN OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION BLO❑
NE SUNSET MILE POST
e 4600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e DUVALL AV NE
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4252603915 0 1 30
6 LAST NAME GANNON FIRST NAME VIRGINIA MIDDLE E 1 1 2 31
INITIAL
STREET ] 7537 135TH AVE SE CITY; NEWCASTLE ST I WA ZIP' 980593115 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NOW INTERLOCKYES NO�/ YEs NO�/
DRIVER' # STATE WA SEXI F MMDDYY' 01 - 20 - 1962 1 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET CLASSY 1 NAruRE of INJURIES 2
10 aI ENSrtEI AYL6067 STATE WA VIN# JF2SJAFC6GH497212 3
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR rRLR 7 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZOI6 MAKE SUBA MODEL FOREST STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 5 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO JOHN GANNON 7537135TH AVE SE NEWCASTLE WA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 3 4
4 LIABILITY INSURANCE INSURANCE CO
14 Z usaa 002801114c
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
15
Lemur yes❑NO❑ CITATION# 7 0 80TTOM
❑ sTnNowc 7 e
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES f/ NO D:2069195444
16�
LAST NAME PAEZ-GARITA FIRST NAME EMILY MIDDLE'
INITIAL
17
STREET ❑ 37
NEW ADORE SS❑ 11619 SE 184TH ST CITY' RENTON ST, WA ZIP 980587234
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES No jNTERLOCK YE NO vEs No
19 DRIVERS
MMDDYY I —
:
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS 1 ❑
21 PLAT# CDL1923 TATE WA VIN# 4T1K61BK7NU064012 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE TOyT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO�/ VES NO�/
REGISTERED OWNER INFO THUYNGUYEN 1813 BURNETTAVE S RENTON WA 98055 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
IAEFFECTNSURANCE[Z &.POLINSURICY# CO STATE FARM 5175077F1447 gTOP _
VEH1CLE YES❑ NC❑ CITATION# 5AO875565 CHARGE FAIL TO OBEY TRAFFIC CONTROL is sorTom
LecnLLv
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG48300
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9723
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) GANNON JOHN F
ADDRESS&PHONE#
7537 135TH AVE SE NEWCASTLE WA 980593115 SEXi M MMDooYBYYY 03 IT
27 - 1954
PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�, 1 POS. 3 2 4 1 USE CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) NGUYEN ANDY N
ADDRESS&PHONE# D 0 B
1813 BURNETT AVE S RENTON WA 980554214 SEX M MMDDYYvr 06 - 29 _ 2005
PASSENGER a WITNESS UNIT# 2 INJURY NATURE OF INJURIES
POS.SEAT ' 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMETUSE CLASS 1 ----�
: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 at intersection of NE Sunset Blvd waiting to turn left onto Duvall Av NE, facing east heading
north. Unit 2 traveling south on Duvall Av NE at the intersection of NE Sunset Blvd. Unit 2 ran red
light causing collision within the middle of the intersection. Unit 2 collided with Unit 1 causing minor
though reportable non disabling damage to the front driver side of Unit 1 and to the front passenger
side of Unit 2. No injuries reported. Unit 2 driver admitted to running red light. Unit 1 driver reported
having the protected left turn arrow. Unit 2 driver was the proximate cause of the collision. Unit 2
driver was cited accordingly.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 11-09-25 01:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
M.BRAUN 2194 1111312025 11:40:59 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:54 PM TIME POLICE ARRIVED i 7:56 PM
PAST B 3 Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG48300 CASE# 25-9723 DATE AND TIME 11/08/25 19:53
OF COLLISION
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