HomeMy WebLinkAbout23-3565 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3565 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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 03 - 1-- 2023 1153 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE CARR RD MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 105TH PL SE
0 4 29
UNIT MOTOORVECL PI CYCLE
ElDDAMYESA✓NOESHOLDMET PHONE 0 11
30
6 LAST NAME MARCA PASACA FIRSTNAME TROTSKY MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 17800 140TH AVE SE CITY RENTON ST WA ZIP 980586823 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 2 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CAG6036 sTArI WAurN# 4S3GTAA66K3752382
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2019 SUBA IMPREZ DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO ALBA PASACA RAMON 17800140THAVE SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME, 3 4
IN EFFECT &POLICY# 9TOP
LE
1 5 36
LEGALLY YES❑NO❑ CITATION# 3AO081112 CHARGE FAIL YIELD LEFT TURN MOTOR )o eorrom
15❑ 1ND'ING 8 6
T 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ riWNERMOTO RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME FERNANDEZ FIRST NAME ROGELIO MIDDLE I D
INITIAL
17❑ STREET ❑', 11638 SE 184TH ST CITY RENTON ST WA ZIP 980587233 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19[ LDI IVE STATE WA SEX DDY
M M D.C.B.
12 _ 06 _ 1974 39
20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET 5 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS NECK
21❑ LICENSE 7G1258 TArE I WA VIN1 1HD1TAN18F6954574
❑ 41
pLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE Hp MODEL FLTRUSE STYLE MC VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO✓
REGISTERED OWNER INFO ROGELIO FERNANDEZ 13701 SE 201ST ST KENT WA 98042 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME, 9TOP 5
VETILE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED46969
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3565
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.
M.LEVERTON 03-29-23 12:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 313012023 3:32:45 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 11:54 AM TIME POLICE ARRIVED',11:56 AM
PART I PAGE IT]OF 4�
REPORT NO. ED46969 CASE# 23-3565 OF COLLISION
03/29/23 11:53
OF CbLLI510N
NARRATIVE
silver unit 1 lane left turn blue me lane 1 eb unit 1 waved and went
CC
Within the city limits of Renton/King/WA I responded to a car v motorcycle crash at SE Carr Rd at
105th PI SE.
I contacted the driver of unit 1 who told me he was making a left turn onto 105th from WB Carr. He
said traffic in lane 2 was stopped and a driver waved him to go. As he made his left turn he told me
he didnt know why unit 2 did not stop for him and that he was going very fast. He did not complain of
injury and damages did not require a tow truck.
I contacted the rider of unit 2, he was being treated by Renton Fire at this time. He told me he was
headed east on Carr lane 1 when unit 1 turned left in front of him. He did complain of injury and but
was not transported-treated on scene and released. Damages did require a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW left turn injury crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 3/29/2023
PAGE 3 OF 4
REPORT NO. ED46969 CASE# ' 23-3565 DATE AND TIME 03/29/23 11:53
OF COLLISION
is
r
I
PAGE 4 OF 4