HomeMy WebLinkAbout23-242 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
INTERSTATE CITY STREET FIRE
CASE# 23-242 2
❑ � RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HIT& F ❑ LOCAL AOENC 3
HIT&RUN Cbt11NC'
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF 02 OBJECT 1 1 8 28
UNITS ' ❑
RESERVATION STRI#CK 2
3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cat�usloN' 01 - 06 - 2023 1811 17 ❑.❑ S 8 W� OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
408 MONROE AVE NE BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ W❑ 0 4 29
U '� MOTOR ❑ PEDAL- El AGE THRESHOLD MET PHONE
01 VEHICLE CYCLE. YES
No F,/ I D:2533484356 0 11
30
6 LAST NAME TOMLIN FIRSTNAME ANTHONY MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 32021 11TH PL S APT Cl CITY FEDERAL WAY ST WA ZIP 98003 2
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NOZINTERLOCKYEs NO�/ YES R No,/
8❑ LRIIVERCENS # STATE WA SEX 1'M MM D Y' 02 — 10 — 1972 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
❑
LICENSE CBV3727 sTArI WWAurN# 1FMZU73EXYZC18395
3
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR 2000 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 FORD EXPLOR DAMAGE YES NO YES[:] No
./
REGISTERED OWNER INFO ANTHONY TOMLIN 3212111TH PL S APT Cl FEDERAL WAY WA 98003 D:2533484356 VEHICLE NO. 1
❑ Y ❑
SHADE IN DAMAGED AREA 35
❑ LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 PROGRESSIVE 961207205
IN EFFECT &POLICY# 9TOP
vEHICE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4256918231
VEHICLE CYCLE : OWNER YES�/ NO
16�
LAST NAME LARA FIRST NAME MICHAEL MIDDLE
INITIAL
17 STREET I❑ s❑' 3901 NE 7TH ST CITY' RENTON ST WA ZIP 98056 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO INTERLOCK YEs❑NOF YEs❑NOF,/
19� LICENSEDNEWS STATE WA SEX M M D.O.B. 01 14 1997 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AUH0339 TArE 41
WA vIN1i 1NXBU4EE8AZ272794 1
42
22❑ PLATE# STATE PLATE#ILER STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2010 MAKE TOYT MODEL COROLL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO�/
REGISTERED OWNER INFO MICHAEL LARA 3901 NE 7TH ST RENTON WA 98056 D:4256918231 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU Ri PORGY#E CO STATE FARM 519 0241-AO5-47IN 9TOP 5
vE""LE ❑ N`L J
,J� CITATION# CHARGE io BOTTOM
LEGALLY YES
OQ
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED22816
COLLISION REPORT III III III III III 111
1591972 CASE# 22-242
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
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.
JAKE GALL 01-06-23 09:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 117/2023 5:05:16 PM
BADGE OR ID# 112617 OR]# WA0171300 TIME POLICE DISPATCHED 6:16 PM TIME POLICE ARRIVED',6:17 PM
PART I PAGE IT]OF 4�
E AND
REPORT NO. ED22816 CASE# 22_242 OF COLLISION 01/06/23 18:11
OF COLLISION
NARRATIVE
The following occurred within the City of Renton, King County WA.
On 01/06/2023 at around 1811 hours, I responded to a two-vehicle collision located at 408 Monroe
Ave NE.
I arrived on scene and contacted the driver of Vehicle 1. Driver 1 stated that he was attempting to
take a left turn (southbound) out of the driveway of 408 Monroe Ave NE. Driver 1 stated that he did
not see vehicle 2 traveling Northbound on Monroe Ave NE, in lane two of two (lane closest to the
center). A larger truck was in lane one of two, who was attempting to pull into the same driveway
vehicle 1 was pulling out of. The larger truck obstructed vehicle 1's view of vehicle 2. Vehicle 1 pulled
out and contacted vehicle 2 on the front passenger quarter panel causing major body damage. Driver
1 was able to provide all necessary documents.
Vehicle 1 had minor scrapping and paint transfer to its front bumper.
I next spoke with driver 2. He confirmed the same story as driver 1. Vehicle 2 was traveling
northbound on Monroe Ave NE when vehicle 1 was attempting to turn southbound onto Monroe Ave
NE, causing the collision. All necessary documents were collected. Again, vehicle 2 had major body
damage to the front passenger quarter panel.
I helped facilitate the exchange of insurance information for both drivers. I also provided my business
with the case number attached.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Gall/12617
01/06/23 at 2030 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. ED22816 CASE# ' 22-242 DATE AND TIME 01/06/23 18:11
OF COLLISION
O
CD
C
not to scale Z
m
NE 4th St
i
PAGE 4 OF 4