HomeMy WebLinkAbout23-2285 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-2285 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
cawsloN 02 - 1-- 2023 1350 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
PARK AVE N BLOCK NO. e✓ 1000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e N 10TH ST
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO ✓ I D:2068999907 30
6 LAST NAME JIMENEZ GARCIA FIRST NAME ZULMA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 32512 1 ST LN SW APT D202 CITY FEDERAL WAY ST WA 2jp, 980236000 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BLC1873 sTAr� WAvIN# 3N1AB7AP2HY381731
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12❑ VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13❑2 2017 NISS SENTRA SD DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO ZULMA JIMENEZ GARCIA 325121STLN SWAPTD202 FEDERAL WAYWA 98023 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 4034263DO647A 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE El PEDAL-
❑ ❑ OWNER ❑ YES✓ NO D:2063543262
16 a
LAST NAME DEVOL FIRST NAME DANA MIDDLE H
INITIAL
17❑ STREET ❑' 525 BELMONT AVE E APT 7C CITY' SEATTLE ST' WA ZIP 98102 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 DRIVER #
20 ON DUTY❑ FN—ATUREOF INJURIES
STATUS 3 AIRBAG RESTR EJECT H U MEET LASSLjRY 6 ABRASION ON LEFT KNEE 40
❑21❑ TArE LICENSE vIN 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 Q 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED37322
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2285
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VALLEJOS BRYAN C
(LAST FIRST,
ADDRESS&PHONE#
525 BELMONT AVE E APT 7C SEATTlE WA 98102 2064125411 SEX M MMDDuyvv 07 - 02 - 1967
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ SEA USE CLASS
NAME
(LAST,FIRST MIDDLE INITIAL) JIMENEZ LOPEZ GABRIELA
ADDRESS&PHONE# D O B
28705 34TH AVE S APT A301 AUBURN WA 98001 2067695530 SEX: F MMaDuvvv 12 _ 30 _ 1985
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIRST,MIDDLE INITIAL) MEKURA CHRISTINA
ADDREss&PHONE# 1205 GRANT AVE S APT 5105 RENTON WA 98055 2064095667 SEX F D.O.B. 01 _ 28 _ 1974
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
Witnesses advised the pedestrian, DANA DEVOL, was crossing the street from west to east on a
marked crosswalk with the cross signal allowing him to cross. Witnesses stated the vehicle (vehicle
#1), WA plate BLC1873, being driven by the driver, ZULMA JIMENEZ, was stopped at a red light on
Park Ave N just north of N 10th St. The vehicle then started to turn to the right onto N 10th St.
Witnesses stated that while the vehicle turned to the right, the front right corner of the vehicle collided
with DEVOL as he started to cross at the cross walk. Witnesses advised the vehicle then drove away
without first exchanging information. The driver of the vehicle, ZULMA, drove into a parking lot
approximately one block away and called police to report what happened, and claimed to the
dispatcher that she did not hit the pedestrian. ZULMA agreed to return to the scene. Once she
arrived, I spoke to ZULMA. ZULMA told me when she started to make the right turn onto N 10th St, a
man stood in front of her car and started hitting her car with his hand, and yelled profanities at her.
He claimed she hit his husband, who was now laying on the ground in the middle of the crosswalk.
ZULMA insisted to me that she did not hit the pedestrian, which was why she left the scene and
parked in a nearby parking lot to call police in order to give her side of the story. I did not see any
damage to ZULMA's vehicle. Photos were taken of the scene, though no video surveillance was able
to be located. The pedestrian, DEVOL, was transported to the hospital by ambulance with what
appeared to be minor injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 02-25-23 03:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 2/26/2023 4:37:07 AM
BADGE OR ID# 11631 OR]# WA0171300 TIME POLICE DISPATCHED 1:54 PM TIME POLICE ARRIVED:1:57 PM
PART I PAGE IT]OF 3�
REPORT NO. ED37322 CASE# ' 23-2285 DATE AND TIME 02/25/23 13:50
OF COLLISION
Not to scale
(D
YNJIF
Vehicle#1
N 10�h t
Pedestrian
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