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Home My WebLink About23-10506 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-10506 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 TOTAL#OF OBJECT 1 28 TRIBAL UNITS 03 STRUCK' FENCE RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 09 - 11 - 2023 1957 17 ❑.= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NILE AVENUE NE BLOCK NO. e✓ 1000 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 75 00 FMILES EET e S B W e SE 116TH STREET 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4255198437 30 6� LAST NAME KWONG FIRSTNAME KENNETH MIDDLE 1 2 31 INITIAL STREET ❑, 506 QUINCY AVENUE NE CITY RENTON ST WA 2jp, 98059 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 5 NATURE OF INJURIES z❑ USE CLASS DRIVER CHEST PAIN,BLACKED OUT 3 10 PI ENSE 781NJE STATE WA VIN#' 1HGCG165X2AO24290 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 5 33 12❑ VIN#' VIN# FROM 34 13� VEH.YEAR2002 MAKE HOND MODEL ACCOR STYLE SD VEHICLE TOWED NOOpLSABLIN T� I� RSTOWING YEs❑ No� VEHICLE DAMAGE IILLJJII REGISTERED OWNER INFO KENNETH KWONG 506 QUINCYAVENUE NE RENTON WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE INSURANCE CO STATE FARM 018.8606-E13.47D 4 IN EFFECT &POLICY# 9TOP vEHICLE CHARGE 5 36 LECALLv res❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UN�T a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑Ems No 1/ D:2069131431 16❑ LAST NAME GEISSLER FIRST NAME KRISTI MIDDLE L INITIAL 17❑ STREET ❑', 1019 NILE AVENUE NE CITY' RENTON ST WA ZIP 98059 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19F] DRIVE # STATE SEX F M D.C.B. 02 �- 11 _ 198 1 39 INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ TATE LICENSE VIN# 41 PLATE# 42 22❑ PR TRAILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO IGQ VEHICLe ❑ ,.I—I CITATION# CHARGE LEGALLY YES N`LJ 25 s � e 7ESAGIAO S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 1 10339 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED98987 COLLISION REPORT III III III III III 111 1591972 CASE# 23-10506 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 PM 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' 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. E.SAGIAO 09-11-23 09:11 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.TRADER 4553 1 911412023 11:34:42 PM BADGE OR ID# 10339 OR]#' I WA0171300 TIME POLICE DISPATCHED 7:87 PM TIME POLICE ARRIVED',8:02 Pm PART I PAGE IT]OF 5� TIME REPORT NO. ED98987 CASE# 23-10506 OF COLLISION09/11/23 19:57 NARRATIVE On 9-11-23 at 1957 hours I was dispatched to a vehicle into a tree in the 1000 block of Nile Avenue NE, in the City of Renton, King County, State of Washington. The vehicle involved was a tan or gold Honda. I arrived and there was substantial damage to the front of the gold 2002 Honda Accord (WA-781 NJE) registered to a Kenneth Kwong out of Renton. Kwong was identified as the driver by his WA DL image. He was bleeding from his face and knees. He told me that he had chest pains then blacked out. There was no indication that Kwong was under the influence. There were parts of the fence lodged through the front windshield. There was a fence damaged in front of 1007 Nile Avenue NE. The owner, Valentine Velasquez relayed he only heard the collision and came out. He saw his mailbox was damaged and part of his fence was gone. He pointed to a large tree in his front yard that Unit#1 obviously struck due to the damage on Unit#1 and the bark and superficial layers of the tree missing. Unit#1 also struck Velasquez's neighbor's mailbox, Kristi Geissler who resides at 1019 Nile Avenue NE. Unit#1 driver had a medical condition and was seen by RFA and Medic 1. He was transported to Harborview Medical Center based on what I was told was an irregular heartbeat. Banker's Towing arrived and towed Unit#1 to their yard. Both property owners and Kwong were provided a business card with this case number. Kwong was provided a copy of the tow form. The incident was captured on my body worn camera. The report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. I certify or declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. E.Sagiao/10339 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED98987 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-10506 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L 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 u PEDESTRIAN � OWNER � YEs� NO D:4255298265 MIDDLE' 29 LAST NAME VELASQUEZ FIRST NAME VALENTINE INITIAL A STREET 30 NEW AnnRFSP 1007 MILE AVENUE NE CITY RENTON ST WA ZIP 98059 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES❑N0� YES N L DRIVER'S STATE SEX M M�DDYBYv 08 - 07 - 1967 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE GLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC E FROM TO DAMAGE Y E ES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnREs.� CITY'. ST ZIP CDL IGNITION REdUiRED IGNITION 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 ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM 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. E.SAGIAO 09-11-23 09:11 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 � BADGE ID# 10339 O#II,WA0171300 AP TRADER 9114/2023 PAGE�OF 5 3000-345-013(R 11118) REPORT NO. ED98987 CASE# ' 23-10506 DATE AND TIME 09/11/23 19:57 OF COLLISION N E'1 fJth SE 116th Street: 1019 Nine A rawe 1007 N oe Av nue NE Nile Avenue NE PAGE 5 OF 5