HomeMy WebLinkAbout22-13785 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13785 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
COLLISION.. 12 - 1-— 2022 1743 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK ST e✓
MILEPOST 500 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e I-405 NB ON-RAMP
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:7148635492 N:7148635492 0 11
30
6� LAST NAME IBRAHIM FIRSTNAME NAGAT MIDDLE I M 1 1 2 31
INITIAL
STREET ❑, 1416 N 30TH ST APT 7 CITy RENTON ST WA 2jp, 980562179 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YES 1/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 5 NATURE OF INJURIES z❑
USE CLASS TRANSPORTED TO OVERLAKE VIA AMBULANCE
3
10 9❑ PlATE14 BV61132 STATE WA vrN#' 1G11C5SL8EF152542
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
TRLR. TRLR 7 1 33
12 3 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 3 7 34
13 3 2014 CHEV MALIBU 4D DAMAGE vEs0NO agW�MEYERS vEs❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO ALLSTATE 914 330 113 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES NO CITATION# 2A0678640 FAIL YIELD LEFT TURN MOTOR o sorroM
15❑ STANDING 8 7 6
MOTOR PEDAL- ',PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065781909 N:2065781909
16 a
LAST NAME PAEZ MIRANDA FIRST NAME PASCUAL MIDDLE
INITIAL
17 STREET❑ NEW ADDRESS❑' 10804 SE 241ST PL APT G202 CITY KENT ST WA ZIP 980305338 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 04 21 2000 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H EET 2 NJAURSY 5 R.ARM PAIN F—NATURE OF .TAKEN TO HOSPITAL BY FAMILY ❑RIES 40
❑21❑ PLATE# CFD2322 TATE 41
WA VIN1 1GNFK16R7TJ382341 1
42
22❑ TRAILER 8O44YQ STATE WA TRAILER STATE
PLATE# PLATE#
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 1996 MAKE CHEV MODEL SUBURB STYLE SV VEHICLETOWED TO BLIN TOWEDII GOV HI �44
24❑ DAMAGE YES�/ NO GENE MEYERS YES NO
REGISTERED OWNER INFO XAVIER PAEZ ROMERO 60229TH ST SE TRLR 103 AUBURN WA 98002 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
Le
L..LLY YES❑ N J CE] CITATION# CHARGE i o BOTTOM
LEGA
25 BADJ a
OFFICER'S NAME(PRINT) OFFICER PHONE GE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED20302
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13785
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PAEZ MIRANDA JESUS
(LAST FIRST,
ADDRESS&PHONE#
2221 NE 6TH PL RENTON WA 98056 2065781909 SEX M MMDOYyry 12 - 23 - 2005
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 3 4 1 USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) NGUYEN KOVY T
ADDRESS&PHONE# D O B
3408 NE 7TH ST RENTON WA 98056 2532055168 SEX: M MMDDY,, 07771
_ 10 _ 1995
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
MATTHEW NUGENT 12-28-22 05:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 12/30/2022 1:40:45 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED; 5:45 PM TIME POLICE ARRIVED',5:50 PM
PART I PAGE IT]OF 4�
REPORT NO. ED20302 CASE# 22-13785 OF COLLISION
12/27/22 17:43
OF CbLLI510N
NARRATIVE
22-13785
On 12/27/2022 at approximately 1745 hours, I was dispatched to a vehicle collision with injury in the
500 block of Sunset Boulevard NE at the on-ramp to northbound 1-405, within the City Limits of
Renton, County of King, State of Washington.
While en route, Dispatch advised that there was a two-vehicle collision, and that both vehicles were
blocking with airbag deployment reported. Dispatch advised that one of the involved parties was
mumbling and therefore the Renton Regional Fire Department was dispatched as a precaution.
Upon arrival, I noticed both involved vehicles had airbag deployment and significant damage suffered
because of a recent collision. Upon contacting the involved parties, the driver of Unit#1 was
mumbling and was actively being treated by Renton Fire. The driver of Unit#2 complained of right
arm pain while the passenger of Unit#2 did not complain of any injury. The driver of Unit#1 was
eventually transported to Overlake Hospital by ambulance for further evaluation. The other involved
parties were treated at the scene. The driver of Unit#2 stated that his family would later transport him
to the hospital.
The driver and sole occupant of Unit#1 was positively identified by pictured WADL. The driving of
Unit#1 stated she was traveling northbound on Sunset Boulevard NE and had proceeded into the left
-turn lane to proceed onto the on-ramp for northbound 1-405. The driver of Unit#1 proceeded out into
the intersection which was controlled by a posted Yield sign where she was met by Unit#2 which was
in the oncoming lane of travel. Both vehicles collided in the intersection causing significant damage to
the front of Unit#1. The driver of Unit#1 later informed me via phone that she was just trying to get
onto the freeway and just remembered the headlights of the other involved vehicle colliding into her
vehicle. He driver of Unit#1 said the next thing she remembered was emergency personnel on scene
with her.
The driver of Unit#2 was identified via pictured WADL and stated he and his juvenile passenger were
traveling southbound on Sunset Boulevard NE approaching the 1-405 overpass. The driver of Unit#2
stated he was intending to continue south on Sunset Boulevard NE. The driver of Unit#2 stated that
while continuing south, he observed Unit#1 pull out into his lane of travel. The driver of Unit#2 stated
he was unable to avoid the collision in time, and subsequently collided with Unit#1 causing
significant damage to the front of Unit#2.
An independent witness, verbally identified as Kovy Nguyen, stated he was traveling southbound on
Sunset Blvd NE and was turning to get onto the on-ramp to proceed north on 1-405. Nguyen stated he
observed Unit#1 fail to yield to Unit#2 during their turn to get on the freeway.
Based on the above statements, I determined that the Driver of Unit#1 (Ibrahim) was the
predominant factor for the collision as Ibrahim did not grant the right of way to traffic already in the
roadway and underway. I cited Ibrahim by mail for failing to grant the right of way while making a left
turn causing a collision.
Both Units had to be towed off scene due to extensive damage. An exchange of information was
provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 5:26 PM 12/28/2022 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED20 0 RASE# 2 d 37 5 DATE m°M\ ]y2/22 ]243
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