HomeMy WebLinkAbout23-2505 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2505 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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 03 - 01 - 2023 0700 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON AVE EXT BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2068329805 2 01
30
6� LAST NAME ALI FIRSTNAME NAIMA MIDDLE O 9 2 31
INITIAL
STREET ❑ 5020 CALIFORNIA AVE SW APT 41 CITY SEATTLE ST WA 2jp, 981361158 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 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BJt4749 sTArI WAvIN# JTMRJREV6JD195075
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 5 7 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 $ 34
13 9 2018 TOYT RAV4 DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO NAIMA ALI 7050S 116TH PL APTB303 SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 934513838
IN EFFECT &POLICY# 9TOP
❑ LEGA LE CHARGE 1 5 36
15 2 VE"'C NG YEs No clTAnoN# 3A0179163 FAIL YIELD PRIVATE RD MOTOR o aorrob
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066839921
16 a
LAST NAME ANGULO MARROQUIN FIRST NAME DEISY IN DOLE y
IN MIDDLE
17❑ STREET ❑', 18822 110TH CT SE CITY' RENTON ST WA ZIP 980557179 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 DRIVER'S STATE WA ]SEX IF D.C.B. 07 O6 _ 1998 39
LICENSE# MMDDYY
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 2 EJECT 1 USE 2 CLASS WRIST PAIN ❑
21❑ LICENSE I D82193A TAre WA vIN1t 3TMCZ5AN0NM467255
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE TOYT MODEL TACOMA STYLE I VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24= DAMAGE YES�/ NO GENE MEYER I YES NO
REGISTERED OWNER INFO OMAR CAMACHO MONFEDA 504 MORRIS AVE S RENTON WA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POLICY#E CO GEICO 6078-09-95-19IN 9TOP 5
VEHICLE ,.I—I CITATION# CHARGE
25 to BOTTOM
LEGALLY YES❑ N
' e
7KLANE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38478
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2505
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TAYLOR TARLUS
(LAST FIRST,
ADDRESS&PHONE#
817 N 4TH ST#308 RENTON WA 98056 2062940931 SEX M MMDDYyry -�-
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
Q✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
MMD D0 Y
PASSENGER []WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
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 in the driveway of McDonalds 77 Rainier AVE S at the north exit which is located on the
south side of Renton AVE Ext. Unit 1 was facing north and planning to turn left onto westbound
Renton AVE Ext. Unit 2 was traveling eastbound in the 100 blk of Renton AVE Ext with the right of
way and was approaching Rainier AVE S and Unit 1. Unit 1 failed to yield the right of way to Unit 2
and initiated this left turn pulling into the path of Unit 2. The front end of Unit 2 impacted the front
drivers side of Unit 1. This description confirmed by witness. Unit 1 sustained moderate damage and
Unit 2 sustained moderate/heavy front end damage. Both Units towed by Gene Meyer.
Driver 1 was cited for failing to yield the right of way when entering the roadway from a private drive
by failing to yield to Unit 2 as it exited McDonalds 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 03-01-23 08:32 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.MORR/S 2613 3/1/2023 8:57:05 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED! 7:02 AM TIME POLICE ARRIVED 7:10 AM
PART I PAGE IT]OF 3�
REPORT NO. ED38478 CASE# 23-2505 DATE AND TIME 03/01/23 07:00
OF COLLISION
0 N
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RENTON AVE EX`. —�`�
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OT MODONALDS
IER AVE S
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