HomeMy WebLinkAbout25-80872 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 25-80872 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� TOTAL#OF OBJECT 1 �2$
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 1810 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DAYTON CT NE BLOCK NO. e✓ 1500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e NE16TH
1 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066592233 30
6� LAST NAME KIM FIRSTNAME HUGH MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 1518 DAYTON CT NE CITY RENTON ST WA Zjp, 980562765 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs 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❑ P1 aT�S� BCX1132 sTArI WAvIN# 3N1AB6APXCL704942
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 0 33
12❑ VIN#' VIN#1 FROM TO
'
2012 NISS SENTRA OIIF nIG m 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED If TO❑BLIN TOWED BY GOVT.VEHICLE
13 4 DAMAGE YES NO YES[:] NO
REGISTERED OWNER INFO SHIN KIM.26 NE 11TH ST RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE Z INSURANCE CO GEICO 4229678026 3
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM1/ THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO D:2063592367
16❑
LAST NAME WARE FIRST NAME MICHAEL MIDDLE H
INITIAL
17❑ STREET ❑', 1519 DAYTON CT NE CITY' RENTON ST WA ZIP 980562766 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK yEEst
II I I NOF YES
t t— l NO❑
19 DRIVE # STATE SEX M MMDDW 11 16 _ 196 7 39
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE LICENSE vIN# 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
"'LE ❑ ,.I— CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25 s � e
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID#
26 12651 [V7�ENCY
A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG60917
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80872
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 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 rolled backwards from driveway of 1518 Dayton Ct NE into driveway of 1519 Dayton Ct NE,
directly west. Unit 1 collided with garage at 1519 Dayton Ct NE. Unit 1 sustained reportable disabling
rear end damage. Residence at 1519 Dayton Ct NE sustained reportable damage to the garage
doors and shared pillar. No injuries. Unit 1 driver reported that vehicle brakes failed.
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 10:22:02 PM
BADGE OR ID# ` 12651 OR]# WA0171300 TIME POLICE DISPATCHED'; 6:13 PM TIME POLICE ARRIVED!6:16 PM
PART I PAGE IT]OF 3�
REPORT NO. EG60917 CASE# ' 25-80872 DATE AND TIME 12/19/25 18:10
OF COLLISION
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