HomeMy WebLinkAbout22-13908 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 22-13908 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4200 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 1731 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 10TH ST BLOCK NO. e✓ 3100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a K/RKLAND AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532441360 0 11
30
6� LAST NAME SMITH FIRSTNAME TAE MIDDLE Y 1 1 2 31
INITIAL
STREET ❑ 2312 NE 6TH PL CITY RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C03233N sTArI WAurN# 1GCUKREC6JF139826
10 PI ATE#
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 2018 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 3 TOWED BY GOVT.VEHICLE 34
13 4 CHEV SILVER PK DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ARCHTERRALANDSCAPING 1302 LAKE TAPPS PKWYE AUBURNWA 98092 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 LIABILITY INSURANCE CHARTER OAK FIRE fNSURANCE BA-4882482A-22-SEL
IN EFFECTPOLICV# TOPVEHICLE CHARGE 36
LECALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4253879600
16 a
LAST NAME PEREZ-RODRIGUEZ FIRST NAME RUBY MIDDLE IG
INITIAL
17 STREET NEW ADDREs7 3513 NE 11TH ST CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVER # STATE WA ]SEX IF M D.C.B. 09 _ 25 _ 2004 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ 41
ILICENSE PLA E# BYT4875 TArE WA VIN# 2G1FC1EV2A9147447 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE CHEV MODEL CAMARO STYLE 2D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NORA RODRIGUEZ-ALFARO 3513 NE 11TH ST RENTON WA 98056 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE I POLICY#E CO SAFECO H2519954IN 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. ED20669
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13908
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HERNANDEZ ADRIANA
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
3030 NE 10TH ST#308 RENTON WA 98056 2068308198 SEX F MMDDYyYv - -
PASSENGER❑WITNESS✓ UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT 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'
On December 30, 2022, at 1731 hours dispatch requested that I respond to a collision that occurred
at the intersection of NE 10th St and Kirkland Ave NE.
Upon my arrival I spoke with the driver of unit 1, a 2018 Chevrolet Silverado bearing Washington
plates C03233N. The driver, identified as Tae Y. Smith (02/18/1971), explained he was going
northbound on Kirkland Ave NE. He stopped at the four-way intersection of NE 10th St and Kirkland
Ave NE. He proceeded forward, did not see unit two crossing, and struck them on the passenger side
doors.
I then spoke with the driver of unit 2, a Chevrolet Camaro bearing Washington plates BYT4875. The
driver, identified as Runy G. Perez-Rodriguez (09/25/2004), explained she was stopped at the
intersection, facing eastbound on NE 10th St. She saw unit 1 coming northbound on Kirkland Ave NE
but had a ways to go before coming to a complete stop. She proceeded forward but was struck as
she crossed the intersection. She believes unit 1 never stopped and ran the stop sign.
While I completed the exchange of information form, a woman named Adriana Hernandez
approached me. Adriana told me she lives in the apartment complex located at 3030 NE 10th St, in
unit 308, which sits on the northwest corner of the intersection. She told me that her 16-year-old
daughter witnessed the entire incident. Her daughter saw unit 2 stop, wait, and then proceed forward
through the intersection. Unit 1 was going northbound, never stopped, and ran the stop sign causing
the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 12-30-22 07:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.CHRISTIANSEN 10437 12/31/2022 7:38:10 PM
BADGE OR ID# 12007 OR]#' ' WA0171300 TIME POLICE DISPATCHED 5:35 PM TIME POLICE ARRIVED;5:37 PM
PART I PAGE IT]OF
REPORT NO. ED20669 CASE# ' 22-13908 DATE AND TIME 12/30/22 17:31
OF COLLISION
NE 10TH ST
UNIT 1
KIRKLAND AVE NE
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