HomeMy WebLinkAbout23-4747 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-4747 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cowsloN 04 - 1-- 2023 1230 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e LIND AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257868407 0 11
30
6� LAST NAME RAMIREZ FIRSTNAME JESSICA MIDDLE D 1 1 2 31
INITIAL
STREET ❑✓ 18918 124TH AVE SE CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 INJURY CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 ATNES# BPE4556 sTAr WAV N# KMHDH4AE5DU016572
7
TRAILER STATE TRAILER
C STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR 7 3. TRLR 33
12 3 5 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2013 HYUN ELANTR DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JESSICA RAMIREZ 1711LI 115TH PL SE RENTON INA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GENERAL 53-WA-6105611 3 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE 5 36
LEGALLY YES No CITATION# 3A0374738 VEH ENTER INTERSEC STEADY RED o Borrom
15❑ STANDING 8 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065101250
16 a
LAST NAME ZURITA ROJAS FIRST NAME AARON MIDDLE M
INITIAL
17❑ STREET ❑', 6012 S 235TH ST APT P202 CITY KENT ST WA ZIP 980323732 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NoF,/
19 LDIIVERIS STATE WA SEX M M .C.B. 03 _ 15 _ 1996 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I TAre VIN1 WBA8D9G52JNU70786
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE BMW MODEL 330 STYLE VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO SOUND FORD 101 SW GRADY WAY RENTON WA 98057 D:4259880607 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN GUARENTEEADP8599112-00 1GQ1
IN EFFECTVEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`E]
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED55403
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4747
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HERRON MAYA A
(LAST FIRST,
ADDRESS&PHONE# D O.B.
4252097132 SEXi F MMDDYYYY 11 - 25 - 1998
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling eastbound on SW Grady Way approaching a red light at Lind AVE SW. Unit 2
was traveling southbound on Lind AVE SW approaching a green light at SW Grady Way. Witness
confirms light color for directions, as well as driver 2. Driver 1 states she was unaware what the light
situation was. According to witness and Driver 2, Unit 1 entered the intersection against the red light
and struck Unit 2 in the intersection. The front end of Unit 1 struck the front passenger wheel area of
Unit 2 causing moderate damage to Unit 1 and moderate and disabling damage to Unit 2. Unit 2
towed by Gene Meyer.
Driver 1 was cited for entering the intersection against the steady red circle (red light) which was the
proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-27-23 01:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 4/28/2023 2:53:49 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 12:30 PM TIME POLICE ARRIVED',12:30 PM
PART I PAGE IT]OF
REPORT NO. ED55403 CASE# ' 23-4747 DATE AND TIME 04/27/23 12:30
OF COLLISION
I
LAND AVE SW
i
G7
*`*NOT TO SCALE-
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