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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 4 i r �., naceux�wam i; e�am� t�ti q�; 31s 1t r j�afl PAGE 5 OF 11 REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION a rk =v v t vi�`rz`�"v °' .. a a• .1,a+�iti m' � w It� Y i �;vy rz rz,:v 1 sk" t t PAGE 6 OF 11 REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION w„ z 4 r i r�\ PAGE 7 OF 11 REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION 'i� ii I{}IrV1V� yylu PAGE 8 OF 11 REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION S . x " " a ,ft YaY, I 4 l7cyy+� 6 z� 4 S L` 2 S-, i } ?1 7S PAGE 9 OF 11 REPORT NO. ED48313 CASE# 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION emu, v t li i ey ;J t;vS i (' �v q, a I nv' t 4` t� M� II y4y4i 4 PAGE 10 OF 11 REPORT NO. ED48313 CASE# ' 23-3823 DATE AND TIME 04/04/23 07:01 OF COLLISION ns et' t unit 3 PAGE OF 11