HomeMy WebLinkAbout23-3372 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-3372 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I 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 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 03 - 1-- 2023 1216 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
L1ND AVE SW BLOCK NO. e✓ 1900 ❑
4a 3❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 19TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:3472679501 0 11
30
6� LAST NAME LEE FIRSTNAME YUN MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 136 102ND AVE SE APT 511 CITY BELLEVUE ST WA 2jp, 980048150 z
NEW
ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LRIIVER # STATE WA SEX'M I EL MI MIT Y
8❑ ' 09 — 07 — 1984 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE BWW3969 sTATI WAVIN#' 3MVDMBDM3MM216280
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR M GOVT.VEHICLE 5 1 34
13 4 2021 MAKE MAZE) ODEL STYLE VEHICLE TOWED CX-30 UT DAMAGE YES No TO BLIN T� � RS YES[:] No
REGISTERED OWNER INFO MIN.LEE 4305 LAKE WASHINGTON BLVD NE 2310 KIRKLAND WA 98033 D:3472679501 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 945692472
IN EFFECT &POLICY# 9TOP
VE"'CLE
15❑ 5 36
LEGALLY YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2063179553
16 2
LAST NAME SU FIRST NAME MIN-CHING MIDDLE N
INITIAL
17❑ STREET ❑', 1652 25TH PL NE UNIT 102 CITY' ISSAQUAH ST WA ZIP 980292607 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C... 07 28 _ 1984 El 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CBK7439 TATe WA VIN# 3CZRU6H53NM737058
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2022 MAKE HOND MODEL yR_V STYLE UT —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 922276167IN STOP 5
VEHICLE ❑ C[ CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N
a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
QU/NT TIBEAU 07691 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED45398
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3372
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'
There is utility construction at the intersection of Lind Ave SW and SW 19th St. U-1 stated that he
was east bound on SW 19th St and did not see the stop sign which was posted to a folding barricade
and sitting on the southwest corner of the intersection. He stated that he slowed down at the
intersection but did not stop. He did not see U-2 and proceeded across Lind Ave SW colliding with U-
2. U2 stated that she was northbound on Lind Ave SW when U-1 tried to cross from SW 19th St
directly infront of her. She tried to stop but was unable to avoid the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
QUINT TIBEAU 03-24-23 02:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.SKELTON 9139 312512023 4:45:51 AM
BADGE OR ID# 07691 ORI# WA0171300 TIME POLICE DISPATCHED; 12:16 PM TIME POLICE ARRIVED:12:16 PM
PART I PAGE IT]OF 3�
REPORT NO. ED45398 CASE# ' 23-3372 DATE AND TIME 03/24/23 12:16
OF COLLISION
LN
Lind Ave SW
I
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Not to Scale
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