HomeMy WebLinkAbout23-5073 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-5073 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 05 - 1-- 2023 0815 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 4TH ST BLOCK NO. e✓ 1200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e PARKAVEN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:6262977584 0 11
30
6� LAST NAME LU FIRSTNAME ZHANTAO MIDDLE 1 1 2 31
INITIAL
STREET ❑✓ 659 BLAINE AVE NE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ pl ATFBit BUZ4919 sTArI WA VIN# JTHBJ46G472097590
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 3 0 VIN#' uIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 5 1 34
13 2 2007 LEXS ES 4D DAMAGE YES NO �LIWkkRS YES❑ NO✓
REGISTERED OWNER INFO ZHANTAO LU 2720 SW 343RD PL FEDERAL WAY WA 98023 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 531 0127-A01.47
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE ' S 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065618375
16 a
LAST NAME PSYK FIRST NAME JAMES MIDDLE I T
INITIAL
17❑ STREET ❑', 401 PELLYAVE N CITY l RENTON ST WA ZIP 980575455 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA SEX M M .C... 01 08 _ 1981 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CFD6900 TAre WA VIN# 1FM5K8DH7HGA16547
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE FORD MODEL EXPLORE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO JAMES PSYK 401 PELLYAVE N RENTON WA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POLICY#E CO GE/CO 6116-70-37-42IN 9TOP 5
VEHICLE 25 LEGALLY YES[:] N`,.IL—JI CITATION# CHARGE io BOTTOM
s � a
7c.,o,,CJFO-HNSON
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
0505 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED61699
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5073
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MORSE ANDREW
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2064505632 SEX' U MMDDYYYY -❑
PASSENGER❑ INJURY
WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET CLASS NATURE OF INJURIES
O' SOS. USE
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
CO.JOHNSON 05-05-23 09:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 511912023 6:17:43 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 8:20 AM TIME POLICE ARRIVED 8:Y8 AM
PART I PAGE IT]OF 4�
REPORT NO. ED61699 CASE# 23-5073 OF COLLISION
05/05/23 08:15
OF CbLLI510N
NARRATIVE
U2 NB Park lane #2; U1 WB 4th lane #2; U2 enters int w/green light, U1 red
On 05-05-23 at about 0828 hours I arrived on scene at a collision in the vicinity of N 4th St and park
Ave N. One of the involved vehicles was pulled into a bus turnout on the east side of the roadway in
the 400 block of Park Ave N and the other vehicle was at a gas station to the northwest of the
intersection.
The driver of Unit 01 was identified by WA DL. Unit 01 was west bound in lane #2 (of 4) of the 1200
block of N 4th St. Unit 01 entered the intersection and collided with Unit 02. The driver spoke very
limited English but was able show the location and direction of travel of his vehicle.
The driver of Unit 02 was identified by WA DL. Unit 02 was north bound in lane #2 (of 2) of the 300
block of park Ave N. Unit 02 entered the intersection and collided with Unit 01. The driver of Unit 02
said his traffic signal light was green when he entered the intersection. The driver of Unit 02 provided
contact information for a witness who was no longer on location. I called the witness by telephone.
The witness said the traffic signal for Unit 02 was green.
The damage to both vehicles was consistent with the information provided by both drivers. Unit 01
was towed from the scene and Unit 02 departed under it's own power.
The proximate cause of the collision was Unit 01 failing to comply with a red traffic control light for
west bound traffic on N 4th St. Were it not for the actions of the driver of Unit 01, the collision would
not have occurred.
No infractions or citations issued. Report for information and insurance.
PAGE 3 OF 4
REPORT NO. ED61699 CASE# 23-5073 DATE AND TIME 05/05/23 08:15
OF COLLISION
"Not to Scale"
UnA 01'
N 4th St
Unft 02
Z
`
L
n
PAGE 4 OF 4