HomeMy WebLinkAbout23-08086 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-08086 2 6 0
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2 0 28
TRIBAL 1 02 STRUCK
RESERVATION
2
3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 07 - 14 - 2023 2002 17 =.= S IN 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 5600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 50 00 FEET e S ❑ W / NILEAVNE
0 1 29
UNIT MO IOORVECL Z CYCLE El DAMA NO GE ES_ THRESHOLD MET PHONE 0 5 30
6 LAST NAME THOMPSON FIRSTNAME VERNON MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 34405 NE 16TH ST CITY CARNATION ST WA ZIP 98014 2
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES 1/ NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 10 — 17 — 1969 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 13 EJECT 3 H USE 2 5 CLASS HEAD,NECK,OF INJURIES
LEFT LEG 2
3
10 Fg-1 P1 ATF 14 OK4859 STATE WA u N# JKAZX4P197AO09318
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM ro
TRLR. TRLR 3 7 33
12 4 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T VgyEWk GOVT.VEHICLE 34
13FAl 2007 KMCU ZX6OO MT DAMAGE YES NO """ R$ 7 7 YES❑ NO✓
REGISTEREDOWNERINFO CHRISTOFER RIOS DONIS 1020112TH STSWE203 EVERETT WA 98204 D:2065187047 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI INSURANCE❑ IN CO
IN EFFECT &POLICY# �_OP
VE—LL CHARGE ❑ 36
LEGALLv res❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNFR ❑ YES 1/ NO D:7865596681
16 a
LAST NAME MARRERO FIRST NAME ANGEL MIDDLE L
INITIAL
17 STREET❑ NEW ADOREss❑' 5820 79TH AVE NE CITY EVERETT ST WA ZIP 98270 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19[—] LICENSE# STATE WA SEX U M D.C.B. 03 _ 02 _ 1995 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
❑LICENSE I 21❑ PLA E# CGF2466 TATe 41
WA VIN# 1J4PN2GK6AW109297 1
42
22❑ PLATE# STATE PLATE# STATE
23 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2010 MAKE JEEP MODEL LIBERTY STYLE 17T VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24 DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO ANGEL MARRERO 582079TH AVE NE EVERETT WA 98270 D:7865596681 VEHICLE NO.2
SHADE IN DAGYGED AREA
2 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VE"LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25 s � e
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID#
26 12651 [V7�ENCY
A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED80079
COLLISION REPORT III III III III III 111
1591972 CASE# 23-08086
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RIOS DONS CHRISTOFER J
(I.P.ST FIRST,
ADDRESS&PHONE#
1020 112TH ST SW E203 EVERETT WA 98204 2065187047 SEX i M MMDDYyry 10 - 11 - 1993
PASSENGER L,WITNESS❑,UNIT# 2 POST 7 AIRBAG 1 RESTR. 4 EJECT ? 1 HELMET CLASS : NATURE OF INJURIES
USE CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL) SALAS JONATHAN
ADDRESS&PHONE# D O B
8100 SUNRISE LAKES BLVD 10 SUNRISE FL 33322 9542246558 SEX' M MMDDYv- 09 _ 08 _ 1998
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER PI WITNESS UNIT# 2 PCS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) NIPERT PATRICK
ADDREss&PHONE# 401 ANACORTES AVE SE RENTON WA 98059 4258298619 SEX M D•O•B• 03 _ 04 _ 1963
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 stolen motorcycle traveling west on NE 4th St approaching Nile Av NE. Unit 2 traveling east on
NE 4th St making U-turn just west of the intersection at Nile Av NE. Unit 1 collides with Unit 2,
causing major disabling damage to Unit 1, causing driver of Unit 1 to be ejected after impacting Unit
2. Unit 2 sustains non disabling reportable passenger side damage. No injuries to occupants of Unit
2. Unit 1 driver sustains severe disabling head, torso, and right leg injuries. Unit 1 driver treated on
scene by Fire and Medics and later transported to Harborview Medical Center for further evaluation.
Both Unit 1 and 2 vehicles impounded for evidentiary reasons. Occupants of Unit 2 report that Unit 1
driver ran the red light at the intersection. See associated Aegis supplemental reports under same
case number for further.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 07-15-23 03:27 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 711612023 2:32:41 PM
BADGE OR ID# 12651 ORI#' i WA0171300 TIME POLICE DISPATCHED 8:03 PM TIME POLICE ARRIVED]8:07 PM
PART B PAGE IT]OF
REPORT NO. ED80079 CASE# 23-08086 DATE AND TIME 07/14/23 20:02
OF COLLISION
`Nile v NE -N
UNIT 1
r
UNFF 2
____N E-4th &t
NOT TO SCALE'
L
i
i
I
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