HomeMy WebLinkAbout26-258 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG67666oc� RA
COLLISION REPORT 1591971
❑ ❑✓ FIRERES ED I
CASE#I 26-258 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY ❑ INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E IN eDL�ISION' 01 - 09 - 2026 1517 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N 3RD ST BLOCK NO. e 1500 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8 E e FACTORYAVEN
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4256631141 0 1 30
5 LAST NAME I SEQUEIRA TORREZ FIRST NAME MARCELA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 24013 109TH PL SE J101 CITY; KENT ST I WA ZIP; 98030 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ✓No INTERLOCKYES NO✓ YEs NoF,/
8❑ DRIVERS# STATE WA SEXI F MMDDYY' 12 — 04 — 1998 t 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 9 RESTR 4 EJECT 1 HELMET
2 CLASSY 7 BACKS of INJURIES 2
LICENSE, CNZ4099 STATE WA VIN# ZFBCFAAH8EZ017351 3
10 Fq I as ATP tt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR 7 3 33
12 2 5 TVINRLRRLR vIN#
FROM TO
VEH.YEAR 2014 MAKE FIAT MODEL 500L STYLE UT VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34
13� DAMAGE YES II_II NO ✓ YESII_I) NO✓
REGISTERED OWNER INFO MARCELASEQUEIRATORREZ24013109THPLSEJ101 KENTWA98030 D:4256631141 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 GE/CO 8631332337
IN EFFECT &POLICY# 4TOP
VEnicLE CHARGE t 5 36
LEc Lv YES❑NO❑ CITATION# 70 80TTOM
15❑ STANDING e
AM EDAL-MOTCYR ✓ P PEDESTRIAN PROPERTY D OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ nWNER YEs✓ THR E
HONo D:2533351055
16�
LAST NAME NGUYEN FIRST NAME THANH MIDDLE V
INITIAL
STREET ❑
17 ❑ 1314 50TH AVE NE CITY AUBURN ST, WA ZIP 98002 q 37
NEW ADORE SS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPQRTED 38
INTERLOCKYEs No✓ INTERLOCK YEs No✓ vEs No✓
19 DRIVER'S
MMDDYY
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE D21770A TATE WA VIN# 3C63R3GJXLG105722 41
22❑ PLAILER TE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE DDDG MODEL RAM STYLE TR VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO THANH NGUYEN 131450TH AVE NE AUSURNWA98002 D:2533351055 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 5804000D2347
IN EFFECT &POLICY# 9TOP
w1— CHARGE
LvEeALY YES❑ NL] CITATION 11
t080TTOM
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
J.TRADER 4553 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG67666
COLLISION REPORT III III III III III 111
1591972 CASE# 26-258
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE GLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
: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
On 01-09-2026 at approximately 1518 hours, I was dispatched to a two vehicle injury collision in the
1500 block of N 3rd ST, in the City of Renton, County of King.
I arrived and Officer Siti Tamaivena was dealing with the driver of Unit 1 who was being treated by
Renton Fire for a possible back injury. The driver of unit 1 was identified as Sequeira Torez with a
WA State license. She was driving vehicle license CNZ4099 in the number one curb lane.
I spoke with the driver of Unit 2 and he was identified as Nguyen with a valid WA State license.
Nguyen said he was driving EB on N 3rd ST in the number two lane when Unit 1 made a lane change
colliding with the driver side front fender of his truck. He did not have any injuries and stated he was
wearing his seatbelt at the time of the crash.
The driver of Unit 1 was in the back of the aid car gagging and appeared to have vomited. 1 did not
make contact with her.
Based on the location of Unit 2 and the location of Unit 1 it appeared Unit 1 made and unsafe lane
change which was the proximate cause of the collision. No citation was issued.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 01-10-26 04:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 111012026 4:22:14 PM
BADGE OR ID# 4553 ORI#' i WA0171300 TIME POLICE DISPATCHED 3:18 PM TIME POLICE ARRIVED i 3:26 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG67666 CASE# 26-258 DATE AND TIME 01/09/26 15:17
OF COLLISION
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