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Home My WebLink About23-4280 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED52173 170 27 COLLISION REP FIT 1591971 CASE 23-4280 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK' TRAFFIC SIGNAL POLE 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 1713 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 4TH ST BLOCK NO. e✓ 4700 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e DUVAL!AVE NE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4252138666 0 11 30 6� LAST NAME PHAN FIRSTNAME CODY MIDDLE T 1 1 2 31 INITIAL STREET ❑✓ 2524 NE 1ST ST CITY RENTON ST WA ZIP 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs No�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS' AIRBAG 6 RESTR I [NATURE OF IN 4 EJECT 1 HELMETU E 2 CLASS 6 LACERATIONS DRIES TO HANDS/LEGS z❑ 3 10[1 PI ATE 14 BXV3227 srAT WAu N#' 1 N46t4BVXKC199761 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 2 3 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR 2019 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 34 13 4 NISS ALTIMA P4 DAMAGE YES NO �MEYER 7 3 TOWING YES[:] ✓ REGISTERED OWNER INFO VICTOR PHAN 2524 NE 1ST ST RENTON WA 98056 D:4252138666 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYA100961175 4 IN EFFECT &POLICY# STOP 15❑ LE vECALLv HICLE 5 36 res❑NO❑ CITATION# CHARGE 1 o BOTTOM STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258913362 16 a LAST NAME CAPLIS FIRST NAME MICHAEL MIDDLE J INITIAL 17❑ NEW STREETR 16025 S 7 E 127TH PL CITY' RENTON ST WA ZIP 98059 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19 LDI IVEW # STATE WA SEX M M D.C.B. 10 _ 18 _ 1985 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 LICENSE I ❑21❑ PLA E# D392586 TATE 41 WA VIN 1 3C6UR5HJ9NG354725 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. TOWEL)By Gov HI 44 VEH YEAR 2022 MAKE RAM MODEL 2500 STYLE 4C DAMAGE TOWED✓ TO NO BLIN GENE MEYER TOWING YES No 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU&PORGY#E CO ALASKA NATIONAL INSURANCE COMPANY 22GAS11208 STOP 5 IN EFFECT VE""LE ❑ Nu,J CITATION# CHARGE io BOTTOM LEGALLY YES 25 ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 D.NELSON 12421 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED52173 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4280 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) PHAN VINCENT T (LAST FIRST, ADDRESS&PHONE# D O.B. 2524 NE 1ST ST RENTON WA 98056 4252138666 SEX M MMDDYyry 06 - 14 - 2002 PASSENGER I�I WITNESS UNIT# 1 SCAT 3 AIRBAG 6 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES L�!1 USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEXt MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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' I was dispatched to a report of a collision in the intersection of NE 4th St and Duvall Ave NE, a witness was reporting a three vehicle collision blocking the intersection. I arrived on scene and located two involved vehicles, I spoke with the occupants of both vehicles and they advised they were uninjured and there was no 3rd vehicle involved. The driver of the gray 2019 Nissan Altima, Cody T Phan (DOB: 5/3/2006), said that he was turning north onto Duvall from EB NE 4th St with a yellow light. He said that he is still learning to drive and had his learners permit. He said that he pulled out into the intersection and "didnt really know what to do" when he was struck by the other vehicle. Cody was treated for minor scrapes by RRFA and cleared at the scene. The passenger, Vincent T Phan (DOB: 6/14/2002) was also cleared at the scene. Gene Meyers Towing removed the vehicle from the scene. The driver of the 2022 Ram 2500, Michael J Caplis (DOB:10/18/1985) said that he was driving west on NE 4th St when the Altima turned in front of him causing the collision. He was evaluated by RRFA on scene and cleared. Gene Meyer Towing removed his vehicle from the scene. A City of Renton crosswalk indicator button/pole was damaged during the collision. RPD Records was advised. Nothing further. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. D.NELSON 04-16-23 06:09 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 411712023 5:43:17 PM BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED 5:14 PM TIME POLICE ARRIVED',5:17 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED52173 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-4280 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:4254307500 MIDDLE.. 29 LAST NAME RENTON FIRST NAME CITY OF INITIAL STREET _—] H 30 NEW AnDRFSP' 1055 S GRADY WAY CITY RENTON ST WA ZIP 98057 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE SEX U M�DDYBYv 01 - 01 - 1990 LICENSE 7 F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREET"[—] ❑ 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. D.NELSON 04-16-23 06:09 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12421 O#I',WA0171300 APPROVED BY 4117/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED52173 CASE# ' 23-4280 DATE AND TIME 04/16/23 17:13 OF COLLISION I I Diwall Ave NE i Vehi€le2 NE4thSt ,.. 1 �T t l PAGE 4 OF 4