HomeMy WebLinkAbout26-5775 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-5775 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
cawsloN 07 - 1-- 2026 2216 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N SOUTH PORT DR BLOCK NO. e✓ 1400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 A❑ 150 00 FEET e S ❑ W e I-405
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:6173196796 0 6 30
g� LAST NAME THANG FIRSTNAME HOA MIDDLE C 1 1 2 31
INITIAL
STREET ❑, 11436 80TH PL S CITY SEATTLE ST WA 2jp, 981783649 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
—, [NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASS 7 I PAIN IN RIGHT WRIST z❑
3
10 9❑ PI ATE 14 CBN5291 sTAr WA u N#' JM3KFBDM4M1308229
- TRAILER STATE PL AT Eft STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 34
13 4 2021 MAZD CX-5 UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO HOA THAN.11,13680TH PL S SEATTLE WA 98178 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 986212123 3 4
IN EFFECT &POLICY# 9TOP
15❑ vECEHA"LE 5 36
LLLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2532939718
16 a
LAST NAME CLEMEN FIRST NAME MIKAELA MIDDLE R
INITIAL
17❑ STREET ❑', 3142 VISTA PL W CITY UNIVERSITY PLACE ST WA ZIP 984662237 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YEs t l NO�
19 DRIVER # STATE WA ]SEX IF M D.C.B. O6 _ 25 _ 1992 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CET7243 TAre WA VIN# 4T1BF3EK88U120168
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2011 MAKE TOYT MODEL CAMRY STYLE SD VEHICLETOWED TO BLIN TOWED By GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NATHANIEL CLEMEN2602NE22NDST RENTONWA98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 962131984 STOP
VEHICLE ❑ CITATION# CHARGE
IN
LLY i o BOTTOM
LEGA YES N`[
25
7UIN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26TIBEAU 7691 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH23725
COLLISION REPORT III III III III III 111
1591972 CASE# 26-5775
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NGUYEN CHLOE
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
11436 80TH PL S SEATTLE WA 98178 2107692695 SEXi F MMDOYyry 08 - 03 - 1996
PASSENGER L,WITNESS❑',UNIT# ; 1 POS USE CLASS 9 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' '1
NAME
(LAST,FIRST,MIDDLE INITIAL) THANG MARK
ADDRESS&PHONE# D O B
11436 80TH PL S SEATTLE WA 98178 SEX M MM 0-:vB 03 _ 02 _ 2025
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER �WITNESS UNIT# 1 POS. 7 AIRBAG 2 RESTR. 11 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
QUINT TIBEAU 07-24-26 12:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 7/24/2026 10:18:39 PM
BADGE OR ID# 7699 OR]# WA0171300 TIME POLICE DISPATCHED; 10:18 PM TIME POLICE ARRIVED',10:21 PM
FART I PAGE IT]OF 4�
REPORT NO. EH23725 CASE# 26-5775 OF COLLISION
07/23/26 22:16
OF CbLLI510N
NARRATIVE
26-5775 RTF
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
On 07/23/2026 at about 2218 hours I was dispatched to a non-injury collision on N Southport Dr at I-
405.
Upon arrival I contacted the parties involved.
The driver of V-1 identified himself as the registered owner, Hoa Thang with his WADL. Thang stated
that he was exiting 1-405 southbound onto N Southport Dr., westbound when V-2 stopped in front of
him. He was unable to stop in time and struck the back of her vehicle. Thang complained of pain in
his right wrist.
The driver of V-2 identified herself as Mikaela Clemen with her WADL. She stated that she was
exiting southbound 1-405 onto west bound N Southport Dr. Another vehicle was coming down the hill
westbound on N Southport Dr in the lane to her left and she thought she was going to have to merge
with it, so she slowed down. V-1 then struck her vehicle from the rear.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Sgt. Q. Tibeau #07691 07/24/2026 0012 hours, Renton, WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: OFFRAMP TO ROADWAY
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EH23725 CASE# 26-5775 DATE AND TIME 07/23/26 22:16
OF COLLISION
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PAGE 4 OF 4