HomeMy WebLinkAbout23-2779 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2779 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cawsloN 03 - 08 - 2023 0855 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EDMONDS AVE NE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NE 24TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069650902 0 11
30
6� LAST NAME GUAN FIRSTNAME LAN MIDDLE N 1 F 2 31
INITIAL
STREET ❑ 2627 NE 25TH ST CITY RENTON ST WA ZIP 980560000 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ pl ATFBit AMR2927 sTATI WAvIN# 5FNRL5H99D6076046
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 3 33
12 3 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2013 HOND ODYSSE DAMAGE YES NO ✓ YES : NO✓
REGISTERED OWNER INFO TAO HU 2627 NE 25TH ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15MOT❑ STANDING 8 7 6
�UITN VE IOOR CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLDMET PHONE
16 a
LAST NAME BULLA FIRST NAME NADEZHDA MIDDLE A
INITIAL
17❑ STREET ❑', 1147 GLENNWOOD AVE NE UNIT F CITY RENTON ST WA ZIP 980563193 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 D IVEW # STATE WA SEX F M D.O.B. 01 11 1980 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CDP4866 TATE WA VIN# 3VWRZ7AJ7AM069440
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2010 MAKE VOLK MODEL JETTA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO NADEZHDA BULLA 1147 GLENNWOOD AVE NE UNIT F RENTON WA 98056 D:4253516420 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO �16
'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
M.LEVERTON 2517 [V7�ENCY
A0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED41061
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2779
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.
M.LEVERTON 03-08-23 09:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 3/9/2023 5:56:55 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 9:99 AM TIME POLICE ARRIVED',9:24 AM
PART I PAGE IT]OF 4�
REPORT NO. ED41061 CASE# 23_2779 O COLLOTINIE
OFF CbLLI510N 03/08/23 08:55
NARRATIVE
red/2 nb maroon stop-24th across
Within the city limits of Renton/King/WA I responded to a 2 car crash at the intersection of Edmonds
Ave NE and NE 24th St.
I contacted the driver of unit 1 who told me she was eastbound on NE 24th St and stopped at the stop
sign facing Edmonds Ave NE. She told me she proceeded when it was clear and contacted with unit
2. She told me she left the scene, went home, contacted her husband and returned to the scene
somewhere between 10-30 minutes later. She did not complain of injury and damages did not
require a tow truck.
When unit 1 and her husband asked about the crash I told them that unit 1 was contributory Ref RCW
46.61.190. Unit 1 driver started to argue saying unit 2 was going way too fast. So I asked why did
she pull out in front of a speeding vehicle. And I thought she said she proceeded when it was clear.
She did not argue any longer.
I contacted unit 2 who told me she was northbound on Edmonds Ave NE when unit 1 crossed her
path while she was lawful upon the roadway and they collided. She did not complain of injury and
damages did not require a tow truck.
Information/Insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 3/8/2023
PAGE 3 OF 4
REPORT NO. ED41061 CASE# 23-2779 DATE AND TIME 03/08/23 08:55
OF COLLISION
AfraL
MF
tNir
PAGE 4 OF 4