HomeMy WebLinkAbout26-4968 TFFiNouCERA II I III 1 III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 26-4968 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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'. 06 - 1-- 2026 1249 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
1405 BLOCK NO. e --- ----� ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e N.SOUTHPORT DRIVE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2536510454 0 4 30
6� INITIAL
LAST NAME SCHWARTFIGURE FIRSTNAME ANDREW MIDDLE 1 1 2 31
STREET ❑ 7015 HOMESTEAD AVE CITY TACOMA ST I WA 2jp, 98404 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 01 1— 03 — 2001 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE CUY0138 sTArI WAVIN# JHMZF1C676S009215
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 4 2011 HOND CR-Z P2 DAMAGE vesNo ves❑ NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 5783505C1247A 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO PHONE
2069921494
16 a
LAST NAME NGUYEN FIRST NAME LOAN MIDDLE I T
INITIAL
17 STREET NEW ADOREs7 538 SHELTON PL NE CITY RENTON ST WA ZIP 980563987 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX F M .C... 01 01 1987 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑
❑ILICENSE 21❑ PLA E# 723ZSU TAre WA VIN# 41
JF2SH66CXAH770898 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE SUBA MODEL FORESTS STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO HAU VU 538 SHELTON PL NE RENTON WA 980563987 D:2069921494 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO STATEFARM 2200078F2747IN 1 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
YUSUF XBRIL 12490 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EH15486
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4968
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VU ISABELLA T
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
538 SHELTON PL NE RENTON WA 980563987 2069921494 SEXi F MMDDYyry 11 - 18 - 2018
SEAT HELMET I INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 POS 7 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 17 HEAD AND NECK
NAME
(LAST,FIRST,MIDDLE INITIAL) MA KENT
ADDRESS&PHONE# D O E9
2062768016 SEX' U MMDDYYYY
PASSENGER []WITNESS POS. USE CLASS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 06/25/2026, at approximately 1252 hours, I responded to a two-vehicle collision at the intersection
of N. Southport Drive and 1405 in the City of Renton, King County, Washington.
Upon arrival, I observed that Unit 1 had front-end damage but remained drivable. The driver of Unit 1
did not report any injuries.
Unit 2 sustained damage to the right rear bumper. The driver of Unit 2 did not report any injuries.
However, the passenger of Unit 2, a 9-year-old seated in the right rear passenger seat, complained of
head and neck pain.
Renton Fire/Medic responded to the scene and evaluated and treated the passenger of Unit 2.
The driver of Unit 1 stated he had been traveling westbound on N. Southport Drive. He reported that
he could not remember whether the traffic signal was red or green when he entered the intersection.
The driver of Unit 2 stated she had been traveling southbound on the I-405 off-ramp and entered the
intersection on a green traffic signal. Unit 1 subsequently struck Unit 2 within the intersection.
I contacted a witness identified as Ken Ma at the scene. Ma stated he was stopped at the traffic
signal on N. Southport Drive, facing eastbound. He reported that traffic traveling southbound from the
1-405 off-ramp was moving through the intersection when Unit 1, traveling westbound on N. Southport
Drive, entered the intersection and collided with Unit 2.
Ma stated he believed Unit 2 had a green traffic signal because traffic exiting the freeway was flowing
through the intersection at the time of the collision.
I provided both drivers with exchanged information and vehicles were driven away.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
YUSUF XBR/L 06-25-26 03:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 1 6/25/2026 6:53:56 PM
BADGE OR ID# 12490 OR]# WA0171300 TIME POLICE DISPATCHED 12:51 PM TIME POLICE ARRIVED';12:55 PM
PART I PAGE IT]OF 3�
REPORTNO.! EH15486 CASE# 26-4968 DATE AND TIME 06/25/2612:49
OF COLLISION
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