HomeMy WebLinkAbout23-3946 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3946 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 04 - 07 - 2023 1637 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2068542405 0 4 30
6❑ LAST NAME SHAW FIRSTNAME CONSUELO MIDDLE M 1 2 31
INITIAL
STREET 01 13225 181 ST AVE SE CITY RENTON ST WA 21p 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 05 1— 05 — 1990 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aTES� BMF3418 sTArr WAurN# 19UUA66256A035096
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 34
13 4 2006 ACUR 3.0 CL SD DAMAG 1 3 E YES NO YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 912P
VEHICLE CHARGE 5 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067129868
16 a
LAST NAME PETRILLI FIRST NAME TIA MIDDLE M
INITIAL
17 NEW STREETREs7' 11014 SE 192ND ST CITY RENTON ST ZIP 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DRIVER #
❑ ON DUTY STATUS I
AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# AEK2346 TArE WA VIN# 41
YS3FA4CY061303060 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2011 MAKE SAA MODEL 9-3 STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO TIAANNETTE 11014 SE 192ND ST RENTON WA D:2067129868 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO TRAVLERS 6003432322031IN I STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N
$
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
PHILIP DAVIS 12018 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED50975
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3946
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'
23-3946
On 4-7-23 around 1653 hours I dispatched to a non-injury/blocking collision in the 4800 block of NE
4th St, Renton, King Co, WA. Initial information was a passerby had heard the collision but was
unaware of the exact location.
While I was still in route other passersby called, but no involved parties called. Upon my arrival I
observed vehicles, AEK2346/WA-Unit 1, and BMF3418/WA-Unit 2, stopped in the middle turn lane
of the 4800 block of NE 4th St. Unit 1 had damage to the rear driver side fender and wheel and Unit 2
had heavy damage to the front of the vehicle and the front bumper was laying on the ground next to
the vehicle.
I contacted Consuelo M Shaw, RO, driver, and single occupant of Unit 2, who advised the following.
Consuelo was driving west on NE 4th St approaching the QFC parking lot when Unit 1 pulled out of
the parking lot in front of Consuelo who was unable to stop in time. Unit 2 collided with the rear driver
side of Unit 1.
I contacted Tia M Petrilli, driver, daughter of the RO, and single occupant of unit 1, who advised the
following. Tia was attempting to turn eastbound onto NE 4th St from the QFC parking lot and turned
in front of Unit 2 causing the vehicles to collide.
Both drivers were checked and cleared by RFA and both vehicles were towed by Bankers towing.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by P Davis 12018 on April 7, 2023 at 17:36 hours in Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
PHILIP DAVIS O4-07-23 06:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 411312023 2:33:43 PM
BADGE OR ID# 12018 ORI# WA0171300 TIME POLICE DISPATCHED 4:53 PM TIME POLICE ARRIVED';4:57 PM
PART I PAGE IT]OF
REPORT NO. ED50975 CASE# ' 23-3946 DATE AND TIME 04/07/23 16:37
OF COLLISION
UFC
.0"11111h,
N
NE 4th St
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