HomeMy WebLinkAbout24-1878 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
SAS 24-1878 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK TREE OR STUMP
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 02 - 1-— 2024 2035 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 1600
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 3 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6 LAST NAME MALAVE SOJO FIRST NAME DAVID MIDDLE D 1 2 31
INITIAL
STREET ❑, 318 2ND AVENUE EXT S CITY SEATTLE ST WA ZIP' 981042604 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
�/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES �/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR 9 EJECT 1 I I [NATURE OF INJURIES
H U EET 2 1 INJURY CLASS ju BLEEDING FROM HANDS z❑
3
10❑ PI ATNE 14 CLM5659 sTAr WAv N# 1HGFA16226L049439
IT STATE TRAILER STATE
11 3 5 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 3 7 33
12❑ vIN#' VIN#
2006 HOND CIVIC SD pL FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 4 DAMAGE YES NO �I YES[:] NO
REGISTERED OWNER INFO JESUS MALAVE S0103182ND AVENUEEXTS SEATTLE WA 98104 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING
UNIT 02 MOTVE IOOR El CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIRIVEWSTICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWEDBY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ &POINSULICY#E CO
IN EFFECT 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE53204
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1878
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SILVIA LOPEZ GREGOR/O
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
20406 INTERNATIONAL BLVD#217 SEA TAC WA 98198 9294869544 SEX M MMDDYyvv 11 - 14 - 1997
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 1 POS. 7 AIRBAG!6 RESTR. 9 EJECT 1 USE 1 2 CLASS 6 CHESTPAIN
NAME
(LAST,FIRST,MIDDLE INITIAL) BOLIVAR GAMEZ ANTHONY
ADDRESS&PHONE# D O B
20406 INTERNATIONAL BLVD#217 SEATAC WA 98198 9294869544 SEX'. M MMDovvvv 02 _ 27 _ 2003
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 6 RESTR, 9 EJECT 1 USE 2 CLASS 6 LEG PAW
NAME
(LAST FIRST,MIDDLE INITIAL) CAMILLO JUAN
ADDREss PHONE# 4710 LAKE WASHINGTON BLVD N 337 RENTON WA 98056 4693382910 SEX M D•O•B• 05 _ 29 _ 1999
MMDDYYYY
PASSENGER WITNESS UNIT# ! 1 SEAT 1 3 AIRBAG 6 RESTR. 9 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
❑ POS. USE CLASS
NARRATIVE'
24-1878
On 2/20/2024 at 2037 hours I was dispatched to a single vehicle collision at 1600 block of NE Sunset
Blvd located in the City of Renton, King County, Washington. I arrived on scene at 2042 hours and
met with Driver 1. The following information is based off of the statements of Driver 1.
Unit 1 was traveling West on NE Sunset Blvd approaching the 1600 block.
Unit 1 came to the curve in the roadway and lost control at around the 1600 block. Unit 1 then
crossed over the Eastbound lanes and then off of the roadway up an embankment. There, Unit 1's
front drivers side door made contact with a tree that was up the embankment. Unit 1 sustained heavy
damage and was rendered inoperable with complex airbag deployment. Unit 1 was occupied by
Driver 1 and 3 passengers.
Injuries
Driver 1 and 2 passengers were transported to Valley Medical Center (VMC) with minor injuries.
Unit 1 was towed by Gene Meyers towing.
This report is to document the circumstances of the collision, damage to vehicles, and both drivers'.
I certify (declare) ender penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 21:09 hours on 2/20/2024, in the City of Renton,
King County, Washington.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 02-20-24 09:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 2/23/2024 6:31:36 PM
BADGE OR ID# 112509 OR]# WA0171300 TIME POLICE DISPATCHED; 8:37 PM TIME POLICE ARRIVED';8:42 PM
PART I PAGE IT]OF 3�
REPORT NO. EE53204 CASE# 24-1878 DATE AND TIME 02/20/24 20:35
OF COLLISION
I
t
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