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COLLISION REP FIT 1591971
CASE 23-3282 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 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 - 1-- 2023 1638 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD STREET BLOCK NO. e✓ 2600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FMILES EET e S ❑ W e EDMONDS AVE NE
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO ✓ D:2069660988 0 7 30
6 LAST NAME SANTOS RAMIREZ FIRST NAME ARMANDO MIDDLE 1 2 31
INITIAL
STREET El 3465 S 144TH ST APT 220 CITY TUKWILA ST WA 2jp, 981686021 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs ✓ I No NTERLOCKYEs NO✓ YES R No
8 LICENSE I # STATE yyq SEX'M MIDI Y' 09 - 03 - 1974 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM
U EET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 C820945 STATE WA uN#' 1GBHG31R9X1102256
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
TRLR. TRLR 3 7 33
12 3 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34
13 2 1999 CHEV EXPRES CG DAMAGE YES NO ✓ YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
LVEHicLe CHARGE 10BOTTOM 5 36
LEGALLv YES�No� CITATION# 3A0055573,3A0055573 INATTENTIVE DRIVING,OP MOT VEH
15❑ �STA"'
U 8 6
MOTOR ✓ PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
NIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]FA.
YES✓ No D:4252461883
16 2
LAST NAME BOLLINGER FIRST NAME SUSAN MIDDLE I D
INITIAL
17 STREET NEW ADDRESS❑' 3812 MONTEREYPL NE CITY RENTON ST WA ZIP 980564208 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DRIVER #
ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 WEB C SET 2 NJAU�Y 6 [-�A—TUREOF INJURIES C/O REACTIVATION OF PR/OR BACK INJURY 40
❑ILICENSE 21❑ PLA E# BKT1682 TATE WA VIN# 41
5J8TB4H70JL022811 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE ACUR MODEL RDX STYLE 11T VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO SUSAN BOLLINGER 3812 MONTEREY PL NE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSURANCE
#E CO FARMERS 3133025840IN 1 9TOP
VE""LE CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES Nu
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED44639
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3282
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.
MATTHEW NUGENT 03-22-23 01:44 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 312212023 4:40:02 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 4:40 PM TIME POLICE ARRIVED 4:51 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED44639 CASE# 23-3282 OF COLLISIONO3/21/23 16:38
NARRATIVE
23-3282
On 03/21/2023 at approximately 1640 hours, I was dispatched to a non-injury and blocking vehicle
collision in the 2600 block of NE 3rd Street, within the City Limits of Renton, County of King, State of
Washington.
While en route, Dispatch advised of a 2-vehicle collision and that both vehicles were blocking one of
the westbound lanes of travel. Upon arrival, I confirmed there were no complaints of injury requiring
immediate medical response at the time of report. I collected each involved party's driving information
and their independent recollection leading up to the collision.
The driver of Unit#1 said he was the sole occupant of his vehicle and was traveling westbound in
about the 2600 block of NE 3rd ST in lane 2 of 2 prior to the collision. The driver of Unit#1 stated he
was traveling directly behind Unit#2 and noticed that Unit#2 suddenly stopped for traffic ahead. By
the time the driver of Unit#1 noticed Unit#2 stopped, he was unable to bring his vehicle to a stop
before colliding with the rear of Unit#2 subsequently causing minor damage to the front end of Unit
#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was traveling westbound in
about the 2600 block of NE 3rd ST in lane 2 of 2. The driver of Unit#2 stated she was stopped for
traffic that had queued at the upcoming intersection. While Unit#2 was stopped, Unit#1 collided with
the rear of Unit#2 causing moderate damage. The driver of Unit#2 believed that because of the
collision, a previous back injury was reactivated.
Based on the above statements, I determined that the Driver of Unit#1 (Santos Ramirez) was the
predominant factor for the collision due to following too closely causing a collision. I cited the driver of
Unit#1 via mail for Inattention. Additionally, the driver of Unit#1 was unable to provide proof of motor
vehicle insurance. I therefore cited Santos Ramirez via mail for Operating a Motor Vehicle without
Insurance.
All involved Units were able to be driven away without further incident. 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 3/22/2023 1:42 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EU44039 CASE# 23-3282 DATE AND TIME 03/21/2316:38