HomeMy WebLinkAbout26-496 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG69763OLCERA
COLLISION REPORT 1591971
❑ 0 RESULTED I
$ 26-496 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 s 28
TRIBAL UNITS OZ STRUCK GUARDRAIL
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N EH INM
eDL�ISION' 01 - 17 - 2026 2220 17 =.�� S W OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION �✓
VUEMONT PL NE BLOCK POST
e 300 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 1❑ 250 00 FMILES NEET e✓ S 8 E e BRONSON WAY NE
1 5 29
MOTOR ✓ PEDAL- F DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES ✓NO 1 4 30
5 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31
INITIAL
STREET
NEW ADDRESS CITY', RENTON ST: ZIP: 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKY NO✓ YES[:]NO;✓
8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' —�— 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT 1 HELM
USEET CLASSY 0 NATURE OF INJURIES 2
LICENSE, CLW3157 STATE WA VIN# JN8BT3DD9PW317575 3
10 F1 PI ATP rt
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR zRLR 0 0 33
12 0 0 VIN#' vIN#
FROM TO
VEH.YEAR ZO23 MAKE NISS MODEL ROGUE STYLE SV VEHICLE TOWED[n TO ZBUN TOWEDBY GOVT VEHICLE m 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO GLORIA PETERSEN 300 VUEMONTPL NE N303 RENTON WA 98056 VEHICLE NO. 1
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE C54�
IN EFFECT &POLICY#VEHICLE CHARGE 36
LecnLLY YES❑NO❑ CITATION#
15❑ sTnNowc s 7 e
UNIT 02 MOTOR Z PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE nWNRR
16❑
LAST NAME NONE FIRST NAME MIDDLE'
INITIAL
17❑ STREET F-1 CITY, OCOEE ST ZIP ❑ 37
NEW ADDRESS
18❑ IGNITION REQUIRED fGNfTION PRESENT MEDICAL TRANSPORTED'. ❑ 38
CDL INTERLOCK Yes NO✓ INTERLOCKYEs �o✓ vEs NO✓
19 LICENS# STATE SEX U MMDDYY E 39
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 1 USE 9 CLASS 1 ❑
21 LICENSE LMCD64 TATE FL SIN USE
41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2007 MAKE HOND MODEL ODYSSEY STYLE VN VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO SAMUEL TEIXEIRADE OLIVEIRA 1975 ERVING CIR APT 108 OCOEEFL 34761 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO NONE
IN EFFECT &POLICY# 9TOP
vewcLE ❑ CITATION11 CHARGE to BOTTOM
EEGnEEY YES N 6
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. EG69763
COLLISION REPORT III III III III III 111
1591972 CASE# 26-496
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 INJURY 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
Unit 1 reversed into Unit 2 within the back parking lot of Lexington Place apartments at 300 Vuemont
PI NE in front of the N building. Unit 1 sustained reportable disabling rear end damage. Unit 2
sustained reportable disabling front driver side damage. Unit 1 also struck a handicap guard rail next
to Unit 2 as well as drove over a curb and bushes. Unit 1 driver gone on arrival. Attempts to speak
with registered owner of Unit 1 at her listed residence in apartment N303 yielded negative results.
Police were also unable to locate the owner of Unit 2 which was legally parked, unoccupied.
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 01-18-26 12:05 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 111812026 2:07:57 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 10:47 PM TIME POLICE ARRIVED 10:52 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG69763 CASE# 26-496 DATE AND TIME 01/17/26 22:20
OF COLLISION
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