HomeMy WebLinkAbout23-2930 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2930 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 03 - 1-- 2023 1702 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 1100
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e EDMONDS AVE NE
2 0 29
MOTU '�01 VEHtOR PI CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE Q 1 30
6� LAST NAME UNKOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑
NEW ADDRESS CITY SEATTLE ST zIP z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 9 CLASRuY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� MJW3658 sTATI TX vN# 1FM5K7D86EGB43702
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 2014 FORD EXPLOR SP DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO ELIZABETH VELAZCO2533 NORTHVIEW DR MESQUITE TX 75150 D:9729975561 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILIT INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEF" CHARGE 1 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT
VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2067556016
16 a
LAST NAME KING FIRST NAME ASHLIE MIDDLE M
INITIAL
17❑ NEW STREETRE87 650 DUVALL AVE NE#Q17-12 CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ MET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLATE# BQN5099 TATE 41
WA VIN# 1J4GA59198L585296 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE JEEP MODEL WRANGL STYLE VT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NEIL CRICHTON 10965 FORESTAVE S SEATTLE WA 98178 D:2067556016 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 4645843-E09-47IN 1UQ,
VEHICLE ❑ ,.II CITATION# CHARGELEGALLY YES N25
7PTAGNE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED49496
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2930
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'
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.
P.LANTAGNE 03-29-23 10:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 4/8/2023 7:42:05 AM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 5:05 PM TIME POLICE ARRIVED',5:16 PM
PART I PAGE IT]OF 4�
REPORT NO. ED49496 CASE# 23-2930 OF COLLISION
03/12/23 17:02
OF CbLLI510N
NARRATIVE
23-2930
On 03/12/2023 at approximately 1702 hours, I, Officer Lantagne, responded to a non-blocking, non-
injury collision near the intersection of NE Sunset BLVD and Edmonds AVE NE, which is located in
the City of Renton, County of King, and the State of Washington. I responded in my fully marked
police vehicle, wearing my patrol uniform. While en route, Dispatch advised one of the vehicles, a
silver Ford Explorer with license plates MJW3658 issued out of Texas, was leaving the scene
southbound on Edmonds AVE NE.
I arrived on scene and observed Unit#2, a 2008 Jeep Wrangler with license plates BQN5099 issued
out of Washington State, parked at the service station on the southwest side of the intersection. I was
advised by the driver of Unit#2, Ashlie M. King (DOB 06/12/1991), there were no injuries.
King told me the following: King was driving eastbound on NE Sunset BLVD. As King's vehicle
approached the intersection at Edmonds AVE NE, Unit#2 which was driving in the lane to the left of
her vehicle, quickly merged lanes into King's lane. During the merge, the right rear fender and
bumper of Unit#1 struck the left front fender and bumper of Unit#2.
King pulled into the gas station and the other vehicle followed. A Hispanic male approximately 30-
years-old got out of the driver's side of the vehicle and a Hispanic female approximately 40-years-old
got out of the passenger side. The male driver quickly walked up to King's vehicle and started rubbing
at the damage to the bumper and was saying that it was fine and there was no damage.
King asked them to get away from her car and cursed at them. King asked the other driver and
passenger for their insurance information and the male driver kept saying he did not speak English.
The female got into the driver's seat of the vehicle and the male got into the front passenger seat of
the Jeep and the vehicle quickly fled the scene southbound.
I observed the damage to the vehicle and other physical evidence was consistent with the statements
made by King. Unit#2 had minor damage to the front left fender which was scraped and the reflector
had been cracked. The left front portion of the bumper had been scraped.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to King. I conducted a records check of Unit#1 and identified
the registered owner as Elizabeth Velazco (DOB 11/28/1983). 1 located a phone number for Velazco
and contacted her.
Velazco told me the following: Velazco's son, George Perez (DOB 04/10/1996), was driving
Velazco's vehicle while Velazco was in the front passenger seat. As Perez was driving eastbound on
NE Sunset BLVD, a black Honda type vehicle started swerving in front of them. Perez swerved to
avoid a collision and Velazco's vehicle struck Unit#2.
Velazco stopped at the gas station to contact the other driver and the other driver got too aggressive
so Velazco left the scene with her son. Velazco did not have insurance for her vehicle and her son did
not have a driver's license.
I was not able to locate a record for Perez.
I later followed up with the gas station and requested a copy of the security video from the incident.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1758 hours on 03/21/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. ED49496 CASE# ' 23-2930 DATE AND TIME 03/12/23 17:02
OF COLLISION
NE Sunset Blvd.
Unat#1
Case#23-2930
0
Not to Scale
P.Lantag:ne#1257
SeS
Unit#2
1 v
i
Edmonds Ave.NE
t
PAGE 4 OF 4