HomeMy WebLinkAbout23-12644 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12644 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
i TRIBAL UNITS 01 STRUCK UT/LITYPOLE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 11 - 1-- 2023 0200 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE NE BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET MILES e S B W e NE 4TH ST
0 4 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElDESA✓NHORESHOLD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY BOTHELL ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICIENSE# STATE SEX u MMDOBYY —F 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 9 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# A6764510 sTAT WAv N# KNAFX4A63G5604328
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 3 33
12❑ vIN#' VIN#
Rom 34
13 4 VEH.YEAR2016 MAKE KIA MODEL FORTE STYLE VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYERS vOs❑ENo�
❑ DAMAGE IILLJJII (�ciV6
REGISTERED OWNER INFO JOSEVELASQUEZ FONSECA 2229164TH PL SE BOTHELL WA 98012 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO UNKNOWN 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGAL
'C YFS❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,DIING 6
UNIT U2 vEHIOCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME ' MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST Zlp ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑
19 LLIICENS # STATE I SEA MMDDYY —=_ 39
-----WELMET NATURE OF INJURIES 4O
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TATE VIN# 41
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
LACY SMITH 12613 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE21695
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12644
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 11/03/2023, 1 was assigned to District 13 as the, 3R13. While conducting routine patrols at
approximately 0255 hours I on-viewed a single-vehicle collision in the 300 block of UNION AVE NE.
This is located in the city of Renton, the county of King, and the state of Washington.
Vehicle WA/A6764510 was not occupied and had collided with a utility pole at the 300 block of Union
Ave NE. It appears the vehicle was traveling Southbound on Union Ave NE when it collided with a
utility pole on the East side of the road.
This vehicle had extensive ignition damage and appeared to have fire extinguisher retardant on the
exterior of the vehicle. Based on my training and experience with stolen Kias, 1 believed this vehicle
to be an unreported stolen. I requested to have Snohomish Co. attempt contact with the registered
owner however due to time delay I had the vehicle impounded by Gene Meyers.
After the vehicle was impounded, I was notified the vehicle was in fact stolen and Snohomish was
taking the case.
I called the registered owner and gave them this case number and informed impound information.
I confirmed the vehicle was no longer in the system as stolen at this time.
This concludes my involvement in this case.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Weather: UNKNOWN
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
LACY SMITH 11-17-23 03:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 11/20/2023 3:40:35 PM
BADGE OR ID# 112613 OR]#` WA0171300 TIME POLICE DISPATCHED! 2:35 AM TIME POLICE ARRIVED 2:35 AM
PART I PAGE IT]OF 3�
REPORT NO. EE21695 CASE# ' 23-12644 DATE AND TIME 11/03/23 02:00
OF COLLISION
I A.
This, Diagram is not, to scale
Unit I
� th
Point of impact
PAGE 3 OF 3