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Home My WebLink About23-05095 (2) ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-05095 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 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 1851 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 3RD BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV a SUNSET BLVD N 0 3 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2061761744 0 81 30 6 LAST NAME GILGUZMAN FIRSTNAME MARCO MIDDLE A 1 2 31 INITIAL STREET ❑ 20625 196TH AVE SE CITY RENTON ST WA ZIP 980580549 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ LICENSE# STATE WA SEX'M I ELMMDDYY 03 — 05 — 2003 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE CLASS ICNLJAURY 1 NATURE OF INJURIES z❑ 3 LICENSE CFG3539 STATE WA uN# 1HGCM665X7AO20530 10 1❑ pl ATE� TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM ro TRLR. TRLR. 5 3 33 12 3 0 VIN#' VIN# :: FROM TO ❑ VEH.YEAR 2007 HOND ACCOR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ BS GOVT.VEHICLE 9 9 34 13 4 DAMAGE YES NO YES❑ No✓ REGISTERED OWNER INFO MARTHA GUZMAN 20625196THAVE SE RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO NATIONAL GEN 2007549441 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLY YES❑NO CITATION# 3A0044272 SPEED TOO FAST FOR CONDITIONS o BorroM 15❑ NDING 6 MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ [:]I YES 1/ NO D:2063998554 VEHICLE CYCLE OWNER 16 a LAST NAME 1 77771CHO FIRST NAME JIMMY MIDDLE H INITIAL 17❑ STREET ❑', 14300 W LAKE KATHLEEN DR SE CITY RENTON ST WA ZIP 980597747 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 D IVEW # INJURY 7 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS NECK BACK ARM PAIN 21❑ LICENSE I CCM2359 TATe WA VIN# 5YJXCBE41GF020248 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2016 MAKE TESL MODEL MODEL X STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO JIMMY CHO 14300 W LAKE KATHLEEN DR SE RENTONWA98059 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE I PORGY#ECO LIBERTY MUTUAL A02-268-142729-40-29 STOP 5 IN EFFECT VE"LE CITATION# CHARGE to BOTTOM LEGALLY YES[Z NEB 6 25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 HANSEN HSU 12651 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED57846 COLLISION REPORT III III III III III 111 1591972 CASE# 23-05095 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME(IAST FIRST,MIDDLE INITIAL) CHO AMYK ADDRESS&PHONE# D O.B. ' 14300 IN LAKE KATHLEEN DR SE RENTON WA 980597747 2063998554 SEXi F MMDDYyry 03 - 31 - 1977 PASSENGER Z WITNESS UNIT# 2 PEAT OS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES USE CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) CHO WESLEY ADDRESS&PHONE# D O B 14300 W LAKE KATHLEEN DR SE RENTON WA 980597747 2063998554 SEX i M MMDDYYYv 05 _ 27 _ 2014 SEAT HELMET I INJURY NATURE of INJURIES PASSENGER Z WITNESS UNIT# 2 PGS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) SAMARDZICH THOMAS R ADDRESS&PHONE# 3605507536 M I. 02 10 _ 1953 SEX. MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 making right turn from Sunset Blvd N to NE 3rd St, south to east. Unit 1 speeding too fast for conditions and veers into Unit 2 who is legally stopped at signal waiting to turn left from NE 3rd St onto Sunset Blvd N, facing west. Unit 1 careers into Unit 2 causing reportable disabling front end damage to Unit 1 and reportable disabling driver side damage to Unit 2. Secondary impact occurs when momentum of initial impact causes Unit 2 to collide with Unit 3, which was also waiting at the light. Unit 3 sustains minor non reportable non disabling damage to driver side. Unit 1 driver cited for speeding too fast for conditions. No injuries reported save for Unit 2 driver, complaint of pain to neck, back and right arm. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 05-05-23 07:54 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 5/7/2023 2:27:50 AM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 6:52 PM TIME POLICE ARRIVED',6:54 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED557846 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-05095 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 tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2062357243 0 8 29 LAST NAME BAHTA FIRST NAME ADDISU MIDDLE'.. G INITIAL STREET 30 NEW AnDRFrtP 4922 147TH PL SW CITY EDMONDS ST WA ZIP 980263918 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO NTERLOCK YES❑N0� YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 07 - 05 - 1966 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BNJ9100 TAr Wq VIN# JM3ER293670125896 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 0 VEH.YEAR2007 MAKE MAZD MODEL CX 7 STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vFH1G P FROM TO DAMAGE YES 'E YES NO REGISTERED OWNER INFOADDISU BAHTA 4922147TH PL SW EDMONDS WA 98026 J 9 33 SHADE IN DAMAGED AREA 7 j 4 12 FROM TO LIABILITY INSURANCE INSURANCE CO STATE FARM 481.0445-A21.47 q"i"Olx IN EFFECT &POLICY# 1 VEHICLE 34 CITATION# CHARGE 10 BOTTUM 13 LEG LEY YES NO ❑ STANDING dRD PROPERTY qg ❑ 35 VEHICLE CYCLE OWNER YSGNO14 UNITr j PHONE 15 LAST NAME FIRST NAME INITIAL 36 MIDDLE ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 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 ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv 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. HANSEN HSU 05-05-23 07:54 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12651 O#I',WA0171300 APTOLLIVER 5n/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED57846 CASE# ' 23-05095 DATE AND TIME 05/05/23 18:51 OF COLLISION Suns NOT TO N'E3ST PAGE 4 OF 4