HomeMy WebLinkAbout26-4849 TFFiNouCERA II I III 1 III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
SAS 26-4849 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENCI 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 5 1 28
TRIBAL 1 OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CtLLISION' 06 - 1-- 2026 1322 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 7TH ST BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e HARDIEAVESW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2065049600 0 11
30
6� LAST NAME NGUYEN FIRSTNAME JUDY MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 404 TAYLOR AVE NW#A CITY RENTON ST WA 2jp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� BUE6851 sTArI WAvIN# 4T1M11AKfLU920703
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 $ 34
13 2 2020 TOYT CAMRY DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO JUDY NGUYEN 404 TAYLOR AVE NW UNIT A RENTONWA98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6245-33.62.65 3 4
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2532316627
16 a
LAST NAME DIDOVETS FIRST NAME JASON MIDDLE Y
INITIAL
17❑ STREET ❑', 1326 3RD ST SE#B CITY'AUBURN ST' WA ZIP 98002 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVERI #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CCK5339 TAre WA VIN# JN1EV7AROJM434865
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2018 MAKE INFI MODEL Q50 STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI �44
24❑ DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO KARINA BUSEVA 13263RD ST SE#B AUBURN WA 98002 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO TRAVELERS 615704433 203 1IN 1 525VEHICLe ❑ C[ CITATION# CHARGE GQ
LEGALLY YES N
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH16969
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4849
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) LU TAM T
ADDRESS&PHONE#
404 TAYLOR AVE NW UNlT A RENTON WA 980573420 2065049600 SEXi F MMDDYyvv 10 - 20 - 1939
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS[] UNIT# 1 POS, 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 7 LEFT WRIST POTENTIAL INJURY
NAME
(LAST,FIRST,MIDDLE INITIAL) BUSEVA KARINA A
ADDRESS&PHONE# D O B
22043 107TH AVE SE KENT WA 980312576 2063719620 SEX'. F MMDDYvvv 08 _ 12 _ 2002
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) UNKNOWN
AppRESS&PHONE# 2065521768 _
SEX V. D.O.B.I. -
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling eastbound on SW 7th ST approaching a controlled intersection at Hardie AVE
SW. Unit 2 was traveling southbound on Hardie AVE SW approaching the controlled intersection at
SW 7th ST. Driver 1 states that she had a green light and proceeded into the intersection. Driver 2
states he had a green light and proceeded into the intersection. Unable to determine which vehicle
had the green light and right of way.
Both units entered the intersection and the front driver's side of Unit 1 impacted the front passenger
side of Unit 2 causing moderate and disabling damage. Both vehicles towed by Gene Meyers.
I attempted to locate footage of the collision but could not locate any. Unable to verify which unit had
the green light and right of way, witness phone was provided but unable to make contact.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-22-26 03:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 71112026 6:39:55 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 1:23 Pry! TIME POLICE ARRIVED 1:24 PM
PART I PAGE IT]OF 3�
REPORT NO.! EH 16969 CASE# 26-4849 DATE AND TIME 06/21/26 13:22
OF COLLISION
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