HomeMy WebLinkAbout26-3110 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-3110 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION 04 - 1-- 2026 0721 17 ❑-❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 17029
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2063540021 0 11
30
6❑ LAST NAME NGUYEN FIRSTNAME WILLIAM MIDDLE M 1 1 1 31
INITIAL
STREET ❑1 19625 104TH AVE SE CITY RENTON ST WA 21p 980557370 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LICENS
DRIVER # STATE WA SEX'M I EL MMDDYY 10 — 26 — 2006 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� D84423J sTArI WAvIN# 4TARN81A2RZ271466
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 1994 TOYT PICKUP DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO DUNG NGUYEN 19625104THAVESE RENTON WA 98055 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 942 198 864 3 4
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
EGHALLY YES❑NO❑ CITATION# 6A0254408 IMPROPER LANE USAGE o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES V NO D:4257655572
16 a
LAST NAME FLUEGEL FIRST NAME HEATHER MIDDLE M
INITIAL
17❑ STREET ❑', 10911 SE 164TH ST CITY' RENTON ST WA ZIP 980555224 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BBK1632 TAre WA VIN# 4S4BSEJC4G3349921
❑ 41
pLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE SUBA4 MODEL OUTBAC STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO MARK FLUEGEL 10911 SE 164TH ST RENTON WA 98055 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 543973709IN 1U�'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99705
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3110
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
POS. 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 FIR57 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 04-22-26 07:58 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 5/4/2026 9:53:07 AM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 7:29 AM TIME POLICE ARRIVED',7:21 AM
PART I PAGE IT]OF 4�
REPORT NO. EG99705 CASE# 26-3110 OF COLLISION
04/22/26 07:21
OF CbLLI510N
NARRATIVE
CC 26-3110
On 4/22/2026 at 0721 hours I was dispatched to a motor vehicle collision at 17029 108TH Ave SE in
the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling South on 108th Ave SE at around the 17000 block.
Driver 1 stated that he was traveling North on 108th Ave SE at around the 17000 block.
Collision
Driver 2 stated that as she was continuing ahead, Unit 1 left its lane and the front drivers side bumper
of Unit 1 collided with and scraped alongside the drivers side front fender of Unit 2, to the rear driver's
side door.
Driver 1 stated that he was unsure what happened but thought that he may have had a mechanical
issue with his vehicle, stating that he did not let it warm up for long enough. Driver 1 stated that Unit 1
crossed the center line and the front drivers side bumper of Unit 1 collided with and scraped
alongside the driver's side front fender of Unit 2, to the rear driver's side door.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited reference RCW 46.61.140.
1 certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 07:50 on 4/22/2026 in the City of Renton, King
County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: MECHANICAL ISSUES
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EG99705 CASE# 26-3110 DATE AND TIME 04/22/26 07:21
OF COLLISION
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PAGE 4 OF 4