HomeMy WebLinkAbout24-2849 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-2849 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 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 03 - 1-- 2024 1600 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e NB/405
❑ �
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2536537114 0 11
30
6� LAST NAME DIEP FIRSTNAME THANHTUNG MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 912 S 36TH P! CITY RENTON ST WA 21p 980555879 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 2 RESTR 4 EJECT 1 H USEET 2 INJURY CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 ATE 14 CKM5418 STATE WA VIN# 5TDAAAB53RS017076
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2024 TOYT HIGHLA UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO NATION WIDE7246J 070572 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:3606604193
16 2
LAST NAME LAZARD FIRST NAME MANUEL MIDDLE I P
INITIAL
17❑ STREET ❑', 27207 122ND AVE SE CITY KENT ST WA ZIP 980308822 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 DRIVER'S STATE WA SEX M D.C... 12 �_ 05 _ 1985 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I CGN4011 TATE WA VIN# KMHRC8A37PU219204
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE HyUN MODEL VENUE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MANUEL LAZARD 16328119TH AVE SE RENTON WA 98058 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 614 5216567IN 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE62769
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2849
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'
On March 15, 2024, at 1600 hours dispatch requested that I respond to a collision that occurred at
Talbot Rd S and 1405 onramp, in the City of Renton, WA.
Upon my arrival I spoke with the driver of unit 2 and he explained he was going northbound in the
number one lane when the collision occurred. As he approached the onramp to 1405 north, unit 1
merged from the right turn lane to the number one lane. Unit 1 struck his passenger side fender, and
then bounced, striking a crosswalk sign that was located in between the onramp and Talbot Rd S.
I then spoke with the driver of unit 2 and she explained she was in the right turn lane. She merged left
but did not see unit 2. She struck unit 2's front fender, bounced, and then collided with the crosswalk
sign.
Both vehicles sustained moderate damage, so they needed to be towed away from the scene. I
provided them an exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 03-19-24 12:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 3/26/2024 2:12:22 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED; 4:02 Pry TIME POLICE ARRIVED';4:16 PM
PART I PAGE IT]OF
REPORT NO. EE62769 CASE# ' 24-2849 DATE AND TIME 03/15/24 16:00
OF COLLISION
I
4
5
h � �
� � Y
,:< i
PAGE 3 OF 3