HomeMy WebLinkAbout23-04583 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-04583 2 0 7
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 1-- 2023 0258 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 5300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET e S ❑ W e JERICHO AV NE
0 1 29
MOTUNIT U1 VEHIOR PI PEDAL-CLE CYCLE ElYYESA�NO GE THRESHOLD MET PHONE 0 11
30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑, UNKNOWN CITY RENTON
NEW ADDRESS ST Zlp'. 2
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LICIENSE#VERS STATE SEX'M MMDDYY _ - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 3 RESTR 9 EJECT 1 H USEET 9 CLAY 0 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATE BMF7995 STATE WA VIN# YS3FH41U661108453
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T VgyEWk GOVT.VEHICLE 3 7 34
13 ZOO6 SAA 9 $D DAMAGE YES NO """ R$ YES❑ NO✓
REGISTERED OWNER INFO JUSTINDANIELS 975 ABERDEEN AVNE B104 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO NONE 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062912524
16 a
LAST NAME VO FIRST NAME ALONZO MIDDLE V
INITIAL
17 STREET❑ NEW ADDRESS❑' 6212 NE 5TH CIR CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 01 23 _ 1961 El
39
LICENSE# MMDDYY
WELMET INJURYf NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
❑21❑ PLATE# C474746 TATE 41
WA VIN# STEUU42N87Z465433 4
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE TOYT MODEL TACOMA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ALONZO VO 6212 NE 5TH CIR RENTON WA 98059 D:2062912524 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 3344263F3147JIN 1 9TOP
"'LE ❑ N`LJ
,.I— CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED56518
COLLISION REPORT III III III III III 111
1591972 CASE# 23-04583
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) UNKNOWN
ADDRESS&PHONE#
RENTON SEX' F MMDDYYYY
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESS❑'UNIT# j 1 POS 3 AIRBAG 3 RESTR. 9 EJECT 1 USE 9 CLASS 7 HEAD CONTUSION FROM
WINDSHIELD
NAME
(LAST,FIRST,MIDDLE INITIAL) ELSHAARI TAHA
ADDRESS&PHONE# D O B
5328 NE 3RD ST RENTON WA 98059 2063355954 M MMDDvyvv 07 _ 31 _ 2005
PASSENGER WITNESS Z UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIRST,MIDDLE INITIAL) EY CARMEN M
ADDREss&PHONE# 4822 NE 5TH CT RENTON WA 98059 4252270677 SEX F D•O•B• 10 _ 03 _ 1957
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NARRATIVE'
Units 1 and 2 both traveling westbound on NE 4th St past Jericho Av NE. Unit 1 rear ends Unit 2
causing major disabling front end damage to Unit 1 and major disabling rear end damage to Unit 2.
Unit 1 driver continues driving vehicle and fled scene until vehicle apparently became inoperative
along the 4600 block of NE 4th St. No injuries reported for Unit 2 driver, Unit 2's sole occupant. Per
passerby witnesses, Unit 1 had two occupants, one white male driver and one female passenger.
Physical evidence on scene indicated that Unit 1 female passenger sustained head contusion due to
damaged windshield despite air bag deployment. Passerby reported observing both Unit 1 driver and
Unit 1 passenger gathered up belongings and both vacated premises on foot after abandoning Unit 1
on street. No victim nor witnesses could identify Unit 1 driver.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 04-24-23 04:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 5/2/2023 2:55:03 PM
BADGE OR ID# 12651 ORI#' i WA0171300 TIME POLICE DISPATCHED; 3:01 AM TIME POLICE ARRIVED',3:03 AM
PART I PAGE 2�OF❑
REPORT NO. EU56518 CASE# 23-04583 DATE AND TIME 04/24/2302:58