HomeMy WebLinkAbout23-3823 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3823 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 04 - 1-- 2023 0701 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EDMONDS AVE NE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 21ST ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067784402 0 11
30
6� LAST NAME WONG FIRSTNAME MATTHEW MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 2033 FERNDALE AVE NE CITY RENTON ST WA ZIP' 980562750 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 H U EET C ASSS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 AT 14 417YZL STATE WA VIN# JHLRD78832C057327
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. $ 5 33
TRLR
12 3 0 VIN#j VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2002 HOND CR-V DAMAGE vEs 0NO f �AWkkRS vEs❑ No✓
REGISTERED OWNER INFO BRYANTWONG 2033 FERNDALEAVE NE RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3AO081119 FAIL YIELD LEFT TURN MOTORMOTO PEDAL- 1 o sorrow
15❑ STAIN.D'ING 7 6
UNI PROPE
T 02 VE ICCLE z CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLDMET PHONE
16 a •,
LAST NAME SARMIENTO CONCEPCION FIRST NAME RAUL MIDDLE N
INITIAL
17❑ STREET ❑', 1156 GLENNWOOD AVE NE CITY RENTON ST WA ZIP 980563014 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA SEX M D.Q.B. O6 _ 22 _ 1978 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C99655P TATe WA VIN1t 1GCEK14K6NZ130479
❑ 41
PLATE# ❑
42
22❑ TRAILER AH9306 STATE WA TRAILER STATE
PLATE# PLATE#
43
23❑ uRNL#R 59KBU1016M1007808 INL#R
VEH YEAR 1992 MAKE CHEV MODEL GMT-400 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO RAUL SARMIENTO CONCEPCION 1156 GLENNWOOD AVE NERENTONWA98056 VEHICLE NO.2
SHADE IN DAGELLAREA
z Cdd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. I 9TOP
Le
L..LLY YES❑ N,J�J CITATION# CHARGE i o BOTTOM
LEGA
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 11
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED48313
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3823
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
POS. 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 04-04-23 08:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 4/4/2023 10:03:02 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 7:02 AM TIME POLICE ARRIVED:7:09 AM
PART I PAGE IT]OF EEI
REPORT NO. ED48313 CASE# 23-3823 OF COLLISION
04/04/23 07:01
OF CbLLI510N
NARRATIVE
blue suv/1 It from 21 blue trk/2 nb w/trl blk coupe/3 parked
CC
Within the city limits of Renton/King/WA I responded to a 3 car blocking crash at Edmonds Ave NE at
NE 21 st St.
I contacted the driver of unit 2 who told me he was north on Edmonds Ave NE when unit 1 turned left
into the side of his truck. This impact caused unit 2 to spin/slide out and contact a lawfully parked
unoccupied car on the east side of Edmonds. Unit 2 did not complaint of injury and damages did
require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was making a left turn from
NE 21st St onto Edmonds and crashed into the side of unit 2. He did not provide additional details on
how he hit unit 2 broadside on a open level roadway with not other sight obstructions. He did not
complain of injury and damages did require a tow truck.
The R/O of the parked vehicle provided me with the registration to his vehicle. Damages to his
vehicle required a tow truck. He said he would make arraignments to have it moved later. The
passenger rear wheel looked like it might have been broken from the impact.
I cited unit 1 via complaint ref RCW 46.61.185 FTYROW left turn 3 car crash.
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 4/4/2023
PAGE 3 OF 11
SUPPLEMENTAL REPORT No. ED48313
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-3823
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL-
PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES� IN
1 4 29
LAST NAME : UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET 30
NEW AnDRFS CITY RENTON ST ZIP
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES No NTERLOCK YES E]Na� YEs N
DRIVER'S STATE I SEX U M��DVSYv' -� 2
LICENSE
7
ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES
F�
USE CLASS
8 ❑ 1 32
LICENSE AIP5227 TAr WA VIN# 1N4AL2EP9CC221103
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2012 MAKE NISS I MODELALTIMA STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1C P FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFODUC HO 2116 EDMONDS AVE NE RENTON WA 98056 m 33
12 � SHADE IN DAMAGED AREA
3 4 FROM TO
((ABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# t 9 1"01?
VEHICLE 1 o BarroM 34
CITATION# CHARGE
13 IEcnuv YES NO
STANDING } 6'&
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15F� I LAST NAME FIRST NAME INIMIDDLETIAL ❑ 36
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES NO NTERLOCK YES NO 'YES NO ❑
17 5 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ vIN 39
LICENSE #
PLATE# rnr
20 ❑ TRAILER' TRAILER ❑ 40
PLATE# STATE PLATE# STATE
21 ❑ [441
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeGALLv
STANDING S 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-04-23 08:02 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 2517 O#I',WA0171300 APJOHNSON 4/44/2023 PAGE F41 OF Fil
3000-345-013(R 11118)
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 5 OF 11
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 6 OF 11
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 7 OF 11
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 8 OF 11
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 9 OF 11
REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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PAGE 10 OF 11
REPORT NO. ED48313 CASE# ' 23-3823 DATE AND TIME 04/04/23 07:01
OF COLLISION
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