HomeMy WebLinkAbout23-3639 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3639 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 28
TRIBAL 1 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 - 31 - 2023 0840 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 1100
4a❑
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:2062492760 0 3 30
6 LAST NAME GARRIDO PAREDES FIRST NAME DANIEL MIDDLE 1 2 31
INITIAL
STREET ❑, 34223 38TH PL SW CITY FEDERAL WAY ST WA 2jp, 98023 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 SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 2❑ I P1 ATNES# C43416E sTAr WAv N# WDOPE845385279325
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2008 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 5 3 34
13 4 DODG SPRINT CG DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYCA00017183 4
IN EFFECT &POLICY# 9TOP
EICLE CHARGE 1 5 36
LVecALHLv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064583549
16 a
LAST NAME PHAN FIRST NAME NANCY MIDDLE
INITIAL
17❑ STREET ❑', 822 S 27TH ST CITY RENTON ST WA ZIP 98055 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 DRIVER'S STATE WA ]SEX IF D.O.B. 03 _ 18 _ 2000 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BMA5119 TAre WA VIN1i 4T1B61HKXJU136807
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
GI
VEH YEAR 2018 MAKE 7'Dy7- MODEL CAMRY STYLE $D DAMAGE TOWED NOO✓ B TOWED BY ov HLIN YES
NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 184 5721-CO6-47FIN STOP
'E""LE Yes Nc❑ CITATION# 3AO018955 CHARGE FAIL TO YIELD MOTOR VEHICLE
,
25 o BOTTOM
LY
' a
0(
OFFICER'S NAME(PRINT)
26 OFFICER PHONE BADGE OR ID# JAGENCY
J.W/SNIEWSK/ 12598 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52138
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3639
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'
On Friday, March 31, 2023 at 0848 hours, I was dispatched to a two-vehicle collision in the area of
the 1100 block of NE Sunset Blvd.
The following occurred within the City of Renton, King County; Unit 1 - WA/ C43416E was being
driven by Daniel Garrido and was driving eastbound on NE Sunset BLVD in the 1100 block. Unit 2 -
WA/ BMA5119 was driven by Nancy Phan and was turning right on NE Sunset Blvd from the parking
lot of 1190 NE Sunset Blvd. Nancy stated she was operating her vehicle when she thought she was
clear of traffic to exit the business on NE Sunset Blvd. Unit 1 was operating in lane 2 when he had to
brake quickly when Unit 2 came into the lane of travel. Nancy stated she was unable to avoid colliding
with Unit 1. The front driver side bumper of Unit 2 collided with the front passenger side quarter panel
of Unit 1. Unit 2 failed to yield to oncoming traffic, which ultimately resulted in a collision.
Nancy was issued NOI 3AO018955 for failing to yield.
Both vehicles sustained damage, however no vehicle needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 03-31-23 09:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 4/17/2023 5:44:48 PM
BADGE OR ID# 12598 ORI#' WA0171300 TIME POLICE DISPATCHED 8:47 AM TIME POLICE ARRIVED';8:53 AM
PART I PAGE IT]OF
REPORT NO. ED5]3 RASE# 2y3 3 A m°M\ 03/3]g30:4
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