HomeMy WebLinkAbout23-3904 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REPOFIT 1591971
CASE 23-3904 z❑
INTERSTATE ❑ CITY STREET El
1❑
STATE ROUTE ❑ OTHER ❑ LOCAL AOENC 4200 3❑CODING
COUNTY RD ❑ PRIVATE WAY ❑
2 3 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# ❑
COLLISION.. 04 - 1-- 2023 1355 17 ❑.= S 8 IN e 1070 3❑
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N 3RD ST BLOCK NO. e✓ 1000 ❑ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES EET ❑ S ❑ E ❑ PARKAVEN
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064308403 0 11
30
❑ LAST NAME ESTRADA RODRIGUEZ FIRST NAME ELIAZAR MIDDLE
6 INITIAL 1 2 31
STREET El 1220 S HOLGATE ST APT B5 CITy SEATTLE ST WA ZIP 981444131 z❑
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3❑
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 07 1— 09 — 1971 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3❑
,OF
Pi ATNES# BVN4340 sTAr WAu N# 1 G6DF577390140012
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 3 34
13 7 2009 CADI CTS DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO ELIAZAR ESTRADA RODRIGUEZ 1220 S HOLGATE STAPTB5 SEATTLE WA 98144 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
❑ LEGALE CHARGE 10BOTTOM 36
15 2 'T""NG YES❑No❑ clTAnoN# 3A0327498,3A0327498 FLD TO YIELD FROM DRIVEWAY OR e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:4252898507
16❑
LAST NAME CASTANEDA BAHENA FIRST NAME BERNABE MIDDLE
INITIAL
17❑ STREET ❑', 3428 NE 6TH ST CITY' RENTON ST WA ZIP 980563949 37
NEW ADDRESS ❑
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑INOR INTERLOCK YEs It I NOF YES
t l NOF,/
19❑ DRIVER #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE D259776 TAre WA VIN1i 3GCEC14X67G230092
❑ 41
PLATE#
22❑ PLATE# STATE PLATE# 42
STATE
❑
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE CHEV MODEL SILIVERA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO MAT CONSTRUCTION LLC 14311124TH AVE NE#19 KIRKLAND WA 98034 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO LIBERTY MUTUAL UNKIN STOP 5
VEHICLE ❑ ❑ CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED50931
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3904
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'
Unit 1 was traveling northbound in the alleyway to the west of Park AVE N stopped waiting to cross
over N 3rd ST. Unit 2 was traveling eastbound on N 3rd ST in the left of three lanes with the right of
way. Driver 1 states a motorist waived him across but Driver 1 failed to assure all traffic was stopped
so that he could safely cross. Unit 1 entered the roadway and drove into the path of Unit 2. The front
end of Unit 2 impacted the driver's side of Unit 1. Both Units sustained moderate/heavy disabling
damage. Driver 1 advised he did not have insurance as no company would insure him due to his
extensive driving ticket history.
Driver 1 was cited for failure to yield the right of way when emerging from an alleyway by crossing N
3rd ST from an alleyway and into the path of Unit 2, which had the right of way on the roadway, and
was the proximate cause of the collision. Driver 1 also cited for operating a motor vehicle without
insurance.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: TRAVERSING OVER TRAVEL LANES FROM ALLEY
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-06-23 03:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 411312023 11:37:14 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 1:56 PM TIME POLICE ARRIVED',Y:00 PM
PART I PAGE IT]OF
REPORT NO. ED50931 CASE# ' 23-3904 DATE AND TIME 04/06/23 13:55
OF COLLISION
1000 blk N 3RD ST
r
r
***NOT T3 SCALE**
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