HomeMy WebLinkAbout23-11769 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11769 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL AOENC 3
HIT IT&8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 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# ❑
cawsloN 10 - 1-- 2023 1544 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e✓ 18000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 180TH ST
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067103630 0 3 30
6 LAST NAME SEVILLA AGUILAR FIRST NAME ANDY MIDDLE L 1 1 2 31
INITIAL
STREET ✓ 1519 TALBOT RD S CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 10 - 21 - 2003 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES 2❑
3
10 1❑ PI ATES 696NRV sTATe OR vN# 4T18F1FK4CU633146
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 5 33
12 2 5 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 $ 34
13 3 2012 TOYT CAMRY SO DAMAGE vE8 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO ANDYSEVILLAAGUILAR 1519 TALBOT RD S RENTON WA 98055 D:2067103630 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# STOP
ve 5 36
'CLE CHARGE
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2063837686
LAST NAME LI FIRST NAME XAN MIDDLE
INITIAL
17❑ STREET ❑', 13360 SE 43RD PL CITY' BELLEVUE ST WA ZIP 98006 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt—TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs❑NOF YES
I�/]NOF 11
19 DRIVER # STATE WA SEX M M D.C.B. 05 _ 05 _ 1957 0 39
W USE
EET LAU Sy FACIAL LACERATION AND BRUISING�NATURE OF INJURIES 40
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 5
21❑ LICENSE ACF8902 TATe I WA VIN# 2HGES16513H626845
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2003 MAKE HOND MODEL CIVIC STYLE SO VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO LISA Ll 14315 SE37THST BELLEVUE WA 98006 D:2063837686 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU POLICY#E CO SAFECO H2414116IN 1 STOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10148
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11769
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SEVILLA RAMOS SANTOS E
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
1519 TALBOT RD S RENTON WA 98055 4255232048 SEX M MMDDvyvv 03 - 04 - 1999
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. 3 2 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) LI LISA
ADDRESS&PHONE# D O 8
14315 SE 37TH ST BELLEVUE WA 98006 2063837686 S E X I F MMODvvvv 07 _ O6 _ 1986
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 southbound on 108th Ave SE. Unit 2 turning right from eastbound SE 180th St to southbound
108th Ave SE. Through Language Line, unit 1 driver Sevilla Aguilar states that he had green light,
and Unit 2 turned in front of him causing collision. Sevilla Aguilar admits that he does not know how
fast he was travelling, and did not know the speed limit. Driver 2 Li unable to speak at scene due to
injuries; passenger 2 Li, Lisa said she believed that Unit 1 was travelling at a high rate of speed when
it hit unit 2, spinning unit 2 around repeatedly. Both cars came to rest approximately 100 yards south
of impact point. Sevilla Aguilar admitted that he did not have a driver's license, only a Honduran
passport. Sevilla Aguilar said that he had just purchased the car two weeks prior, and had no
insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 10-15-23 05:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 1 1011712023 1:35:24 PM
BADGE OR ID# 5738 OR]#' WA0171300 TIME POLICE DISPATCHED; 3:46 PM TIME POLICE ARRIVED',3:49 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE10148 CASE# ' 23-11769 DATE AND TIME 10/15/23 15:44
OF COLLISION
5
f
I
Unit 1
w
ua
a
mom`
Unit 2
SE 180th St
PAGE 3 OF 3