HomeMy WebLinkAbout25-81168 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG65741OLCERA
COLLISION REPORT 1591971
CASE# 25-81168 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LdCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
87
2❑ TRIBAL i UNITS#OF 02 SOTRUCK METAL SIGN POST 28
i RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 12 - 30 - 2025 1916 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 11TH ST BLOCK NO. e 1100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1.1 FEET e S 8 W e NE SUNSET BLVD
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 30
6 LAST NAME DICKSON JR FIRST NAME ANTHONY MIDDLE J t 1 2 31
INITIAL
STREET ] 2955 NE 11 TH ST APT A454B CITY; RENTON ST WA ZIP; 980563410 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEflIQAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YEs N0✓
8❑ DCIENSE# STATE WA SE XI M MMDDYY' 04 - 24 - 1986 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CKF4327 STATE WA VIN#; 3FA6POH91GR110418 3
10 F1 PI ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM TRLR 1 5 5 33
12= VIN zRLR#' VIN#
FROM TO
VEH.YEAR ZOI6 MAKE FORD MODEL FUSION STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE m 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO CAROLINE MEHAN 1.1 SUNSETBLVD NEAPT8 RENTONWA98056 VEHICLE NO. 1
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE 3 4
IN EFFECT &POLICY# 4TOP
CHARGE t VEHICLE 5
Lemur yes❑NO❑ CITATION# 36 7 0 80TTOM
15❑ srANowc e
�y MOTOR PEDAL-:. pROpERTY DAM THR OLD MET PHONE
UNIT U2 PEDESTRIAN ✓
VEHICLE CYCLE' OWNER YES✓ NO
16❑
LAST NAME RENTON FIRST NAME CITY OF MIDDLE
INITIAL
17 F1 STREET ❑
❑ 1055 S GRADY WAY CITY RENTON 5T, WA ZIP 98055 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED': ❑ 38
INTERLOCKYES No INTERLOCK YES Nz YES N0
19 �CENS# STATE SEX U MMODYY = 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASS ❑
21 1
PLATE# rare vIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23= TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24= DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
YemcLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGAEEY YES NC
25 s s
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. EG65741
COLLISION REPORT III III III III III 111
1591972 CASE# 25-81168
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) GONZALEZ SEBASTIAN
ADDRESS&PHONE# 0
4253011765 SEXi M MMDD'yyYv 06 — 04 — 1997
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1:10' POS. USE CLASS ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYYYY D.O.B. —
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES
POS. USE CIASS ----�
: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 traveling south on NE Sunset Blvd approaching NE 11th St. Unit 1 driver reported veering
away to avoid collision with white Tesla, unkown plate, turning right, striking and knocking down the
metal stop sign at intersection, before coming to rest, striking a concrete retaining wall. Unit 1
sustained reportable non disabling front end damage. No injuries. Unit 1 driver unable to furnish proof
of valid insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-31-25 12:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 1/5/2026 1:07:53 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED; 7:18 PM TIME POLICE ARRIVED i 7:23 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG65741 CASE# 25-81168 DATE AND TIME 12/30/2519:16
OF COLLISION
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