HomeMy WebLinkAbout26-476 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG69585oc� RA
COLLISION REPORT 1591971
❑ 0 RESULTED I
$ 26-476 z
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 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 - 16 - 2026 1855 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
DUVALL AV NE BLOCK NO. e 1600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 F--1 MILES. FEET e S 8 W e NE SUNSET BLVD
OF 2 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:5033829307 0 1 30
6 LAST NAME XU FIRST NAME SHOUSHAN MIDDLE 1 2 31
INITIAL
STREET ] NO 12 GROUP 5 XIANGDANG VILLA WUXUMECHUAN TOWN CITY; CHINA
NEW ADDRESS ST ZIP: 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES NO✓ INTERLOCKVEs No✓ YES NOW
DRIVER # STATE AP SEXI M MMDDYY' 12 — 19 — 1983 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 1
NATURE of INJURIES 2
LICENSE, CTC3012 STATE WA VIN# 5LMJJ2LG7SEL07881 3
10 Fl I PI ATF tt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR zRLR 1 5 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZOZS MAKE LINC MODEL NAV/GA STYLE UT VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 $ 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO HOLDING CORP IV 15820 TUKWILA INTERNATIONAL TUKWILA WA 98188 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑+�NICLICY
SURANCE CO NONE
IN EFFECT Enic� CHARGE 36Lemur yes❑NOTATION# t a BOTTOM
15❑ STANDING I B 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES NO D:3605801744
16�
LAST NAME CAMPBELL FIRST NAME TAYLOR MIDDLE M
INITIAL
17 STREET ❑ 37
4425 SE 4TH PL CITY RENTON ST, WA ZIP 980595128
NEW ADDRESS I I I I I 1
❑
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYEs NO✓ INTERLOCK YESEl
NO✓ YES NO✓
19 DRIVER'S STATE WA SEX F I D.O.B. 04 30 1982 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG'6 RESTR 4 EJECT 1 HELMET INJURY', 7 NATURE OF INJURIES ❑ 40
USE CLASS HEAD NECK PAIN
21 LICENSLATE E BPE6695 rarE WA vIN# 5TDDZRFH7KS979296 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
TOWED BY GOV HI 44
VEH.YEAR 2019 MAKE TOYT MODEL H/GHlAN STYLE UT VEHICLE
TOWED✓ No BLIN BANKERS ves No✓
24
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO GARRISON PROPERTY 024412638R
IN EFFECT &POLICY# t Y 1— ❑ ,o CITATION# CHARGE UR
L,—�Y YES N
25 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. EG69585
COLLISION REPORT III III III III III 111
1591972 CASE# 26-476
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 CLASS 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 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
Units 1 and 2 both traveling south along 1600 block of Duvall Av NE, approaching intersection of NE
Sunset Blvd. Unit 1 veers to his right, colliding with Unit 2 causing reportable disabling passenger
side damage to Unit 1 and reportable disabling front driver side damage to Unit 2. Unit 2 driver
reported possible head and neck pain injuries and was treated on scene by Renton Fire. Unit 1 driver,
a Chinese national, with valid driver license documents, was proximate cause of collision into Unit 2.
Unit 1 was a vehicle rental from Avis.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 01-16-26 09:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1/17/2026 12:35:36 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:56 PM TIME POLICE ARRIVED i 7:58 PM
PAST B 3 Da-3m5—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG69585 CASE# 26-476 DATE AND TIME 01/16/26 19:55
OF COLLISION
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