HomeMy WebLinkAbout25-80868 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 25-80868 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 CITY# ❑
cowsloN 12 - 19 - 2025 1610 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE SUNSET BLD BLOCK NO. e✓ 4700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S ❑ W e DUVALL AV NE
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
F,/No D:4253063492 0 11
30
5� LAST NAME LIU FIRST NAME LUYAO MIDDLE N 1 2 31
INITIAL
STREET ❑ 22500 SE 56TH ST APT 18-101 CITY ISSAQUAH ST WA 21p 980295255 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CVG0933 sTAr� WAurN# JNIDFOB65PM709138
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 NISS ARIYA DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LUYAO L1U 11216 SE 133RD PL RENTON WA 98059 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4105138905 3 4
IN EFFECT &POLICY# 9TOP
VE—L'
15❑ EC 1 5 36
LALLv YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:3605848181
LAST NAME YALCINKAYA FIRST NAME CYNTHIA MIDDLE I L
INITIAL
17❑ STREET ❑', 812 LYONS AVE NE CITY' RENTON ST WA ZIP 980594843 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CTH1214 TAre WA VIN# 5TDADAB53SS017706
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2025 MAKE TOYT MODEL GRAND STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO SERDAR YALCINKAYA 812 LYONS AVE NE RENTON WA 98059 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 03 4 9 72311CIN IGQ"'LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG60915
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80868
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WANG JASON
(IAST FIRST,
ADDRESS&PHONE#
22500 SE 56TH ST APT 18-101 ISSAQUAH WA 980295255 4253063492 SEX M MMDDYyry - -
PASSENGER I�I WITNESS UNIT# 1 SEA 7 AIRBAG 2 RESTR. 4 EJECT ? 1 HELM
USEET (CNJURY LASS 1 NATURE OF INJURIES
POS.NAME L�1
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX( MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
Unit 1 entering/merging into traffic onto the 4700 block of NE Sunset Blvd from the Classic Cleaners
parking lot at 1630 Duvall Av NE. Unit 2 was traveling westbound along the 4700 block of NE Sunset
Blvd. Unit 1 failed to yield ROW entering traffic from private driveway and collided with Unit 2 causing
reportable non disabling front passenger side damage to Unit 1 and reportable non disabling damage
to the center passenger side of Unit 2. No injuries reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-19-25 06:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
M.BRAUN 2194 12/19/2025 10:20:57 PM
BADGE OR ID# ` 12651 OR]# WA0171300 TIME POLICE DISPATCHED 4:25 PM TIME POLICE ARRIVED 4:45 PM
PART I PAGE IT]OF 3�
REPORT NO. EG60915 CASE# ' 25-80868 DATE AND TIME 12/19/25 16:10
OF COLLISION
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