HomeMy WebLinkAbout25-80758 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-80758 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 7 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 12 - 1-- 2025 1319 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
S 15TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e DAMS AVE S
1 9 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE Q 11
30
6� LAST NAME YANG FIRSTNAME CHUANHE MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 26518 PRINCETON AVE CITY KENT ST WA Zjp, 980327005 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CUH1536 sTArI WAurN# 1HGCY2F83SA062263
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2025 HOND ACCOR DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO CHUANHE YANG 26518 PRINCETON AVE KENT WA 980327005 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAFECO H2609815 3
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a uNiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065730687
LAST NAME CISSE FIRST NAME BASSIROU MIDDLE N
INITIAL
17❑ STREET ❑', 5700 S 129TH ST APT F101 CITY SEATTLE ST WA ZIP 981784683 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CMP5982 TAre WA VIN# JTMMWRFV9KD005801
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE TOYT MODEL RAV4 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO BASSIROUCISSE5700S129THSTAPTF101 SEATTLE WA 981784683 D:2065730687 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 POLICY#E CO GEICO 6204569195IN 1ULlliKOTlTlfll;0-
(PRINT)vE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25 OFFICER'S NAME 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. EG60722
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80758
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
PM 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'
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.
M.LEVERTON 12-16-25 02:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/19/2025 1:09:01 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 1:21 Pry TIME POLICE ARRIVED',4:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EG60722 CASE# 25-80758 OF COLLISION
12/16/25 13:19
OF CbLLI510N
NARRATIVE
blu/1 maybe backing maybe stopped gry/2 maybe straight maybe swerved he said he said n
indicators
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash at S 15th St at Davis Ave S.
When I arrived I located one vehicle stopped in the middle of S 15th facing eastbound with its 4 way
flashers active. Another vehicle with airbag deployment stopped at a 45 degree angle in relation to a
private driveway on the outside of the white line.
I contacted the driver of unit . I used Google translator for Chinese to communicate the following.
Unit 1 told me he was seated in his stopped vehicle and pointed to where is was positioned. He told
me he was not moving and was hit by unit 2. He complained of a sore back but declined any checks.
(via Dispatch) The damage to his vehicle did not see anything but minor but a combination of airbags
were deployed.
I contacted the driver of unit 2 who spoke broken English and did not need a translator. He told me
he was east on 15th when unit 1 backed into his lane without room/time to avoid contact. He did not
complain of injury and damages was a flat front passenger tire. He declined a tow truck. I thought he
had changed his tire while I was creating an info exchange, but he drove off on his flat tire to another
house close by.
There was no roadway evidence or debris to indicate POI. 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 12/16/2025
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: MAYBE BACKING
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EG60722 CASE# ' 25-80758 DATE AND TIME 12/16/25 13:19
OF COLLISION
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