HomeMy WebLinkAbout23-3847 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3847 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 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# ❑
cowsloN 04 - 1-- 2023 1547 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
KENNEWICK PL NE BLOCK NO. e✓ Y900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e Fill
1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2063497703 0 11
30
6� LAST NAME DANG FIRSTNAME QUYEN MIDDLE K 1 2 31
INITIAL
STREET ❑ 3503 PARK AVE N CITY RENTON ST WA Zjp, 980561912 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 09 1— 11 — 1972 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATFBit BHZ9901 sTArI WA vrN#' 2T2BZMCA6HC123292
TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# Rom ro
TRLR. 'I'RLR. 9 5 33
12 3 0 vIN#' vIN#i
VIN FROM TO
VEH.YEAR 2017 MAKE LEXS MODEL RX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES 1 $ 34
13 2 YES❑ NO
REGISTERED OWNER INFO QUYENDANG 3503 PARKAVE N RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATEFARM 4654429-E27.47 3 4
IN EFFECT &POLICY# 9TOP
VEHICe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 3AO179193 INATTENTIVE DRIVING I o BorroM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2063305774
16 a
LAST NAME CHEN FIRST NAME YINING MIDDLE
INITIAL
17❑ STREET ❑', 7435 119TH CT SE CITY' NEWCASTLE ST WA ZIP 980561788 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 STATEWASEXFD.C.B.C.. 39
# M
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE ALV5180 TAre WA vIN# 5FNYF4H93D8055125
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2013 MAKE HOND MODEL PILOT STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES,/ NO BANKERS YES NO
REGISTERED OWNER INFO XUN ZHANG 7435119TH CT SE NEWCASTLE WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATEFARM 4771510-C23-47AIN IGQI
VEHICLE ❑ C—I CITATION# CHARGE
LEGALLY YES N`LJ
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED48945
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3847
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'
Unit 1 was parked facing south on the west side of Kennewick PL NE in the 2900 blk. Unit 2 was
traveling southbound in a right-hand curve approaching the 2900 blk of Kennewick PL NE. Unit 1 left
this parked position and entered the lane of travel to the left (east), failing to yield the right of way to
Unit 2 who was passing on the left lawfully. The front driver's side of Unit 1 struck the front passenger
side of Unit 2. Unit 1 sustained moderate damage while Unit 2 sustained moderate but disabling
damage. Unit 2 towed by Bankers tow.
Driver 1 was cited for Inattentive Driving by not driving with due care and caution and entering a lane
of travel from a parked position without assuring this could be done safely which was the proximate
cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-04-23 04:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 4/6/2023 10:12:58 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 3:48 PM TIME POLICE ARRIVED 4:00 PM
PART I PAGE IT]OF
REPORT NO. ED48945 CASE# ' 23-3847 DATE AND TIME 04/04/23 15:47
OF COLLISION
i
ON
***NOT TOSCALE***
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