HomeMy WebLinkAbout24-6580 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-ss8o z
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3
HIT&RUN ✓ CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 0 1 28
TOTAL#OF OBJECT
TRIBAL UNITS 03 STRUCK' RETAINING WALL
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# 6 6
COLLISION'. 06 - 1-- 2024 2158 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
SUNSET BLVD NE ST e✓
MILEPOST 3200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5 A❑ 250 00 FEET e S B W e NE 12TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YEs �/No D:4252874457 1 6 30
5� LAST NAME KANG FIRSTNAME JOHN MIDDLE F 2 31
INITIAL
STREET ❑, 14526 38TH DR SE CITY MILL CREEK ST WA ZIP 98012 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U EETI I INJURY [NATURE OF
CLASS 5 LEFT LEFT/SHINS z❑
3
10 9� P1 AT 14 BXT6012 STATE WA VIN# 2T3A1RFV2MC173255
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2021 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR y GOVT.VEHICLE 34
13 TOYT RAV4 SV DAMAGE YES NO �MEYER 3 7 YES❑ No✓
REGISTERED OWNER INFO JOHN KANG 1112638TH DR SE MILL CREEK WA 98012 D:4252874457 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6126029898 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.D'ING 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME GARCIA SANDOVAL FIRST NAME ANTONINO MIDDLE
INITIAL
17❑ STREET ❑', 1529 JONES AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
INJURY NATURE OF INJURIES 40
20F1 ON DUTY STATUS' AIRBAG RESTR 4 EJECT '1 USE 9 6 CLASS SHOULDER
❑21❑ LICENSE TATE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
GI
VEH YEAR MAKE MODEL STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO✓ 44
24❑ ES
REGISTERED OWNER INFO ANTONINO GARCIA SANDOVAL 1529 JONES AVE NE RENTON WA 98056 VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY INSURANCE❑ INSURANCE CO NONE
IN EFFECT &POLICY# 9TOP 5
VF,A`LE YES N CITATION# 4A0505804 CHARGE DUI,HIT AND RUN Io ao-r-roM
LEGALLY `c❑LJ 6
25 =HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 12651 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE88951
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6580
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SUZUKI CHELSEA N
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
5306 154TH AV SE BELLEVUE WA 98006 4253736786 SEXi F MMDDYyry 01 - 17 - 1993
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑(UNIT# 1 POS 3 AIRBAG 6 RESTR. q EJECT 1 USE CLASS 7 NECK ANDSHOULDERPAIN
NAME
(LAST,FIRST,MIDDLE INITIAL) BASTRO MIRLEY N
ADDRESS&PHONE# D O B
4259193933 SEX U MMDbBvv
PASSENGER [:]WITNESS POS. USE CLASS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
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 2 traveling westbound along 3200 block of Sunset Blvd NE approaching NE 12th St. Unit 1
traveling eastbound along 3200 block of Sunset Blvd NE just passed NE 12th St. Unit 2 veered into
oncoming lane of travel due to suspected alcohol consumption. Unit 2 driver was proximate cause of
collision as he collides glancing driver side head on to Unit 1 causing major disabling front end
damage to both units just east of the driveway to the Oreilly's parking lot at 3213 Sunset Blvd NE.
Unit 2 driver fled from scene and drove further west and caused secondary collision via suspected
overcorrection and crashed into a retaining wall/stair and metal hand railing in front of the Rite Aid
parking lot at 3116 Sunset Blvd NE. Unit 2 driver was later apprehended and arrested for DUI and hit
and run. Unit 2 driver treated for shoulder pain both on scene and at hospital. Unit 1 driver treated for
left leg injury and Unit 1 passenger treated for neck and shoulder pain also on scene and at hospital.
Both vehicles were impounded.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: SECONDARY COLLISION INTO STAIRS/RAILING
**** 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.
HANSEN HSU 06-22-24 12:27 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 6/22/2024 2:10:07 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED! 9:89 PM TIME POLICE ARRIVED 10:02 PM
PART I PAGE IT]OF 4]
SUPPLEMENTAL REPORT NO. EE88951
r` POLICE TRAFFIC 1 27
COLLISION REPORT CASE# 24-6580
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST' ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs� IN
MIDDLE' 29
LAST NAME RENTON FIRST NAME CITY OF INITIAL
STREET 30
NEW AnDRFSP' 1055 S GRADY WAY CITY RENTON ST WA ZIP 98055
6
II 1 31
CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T
DRIVER'S STATE I SEX U M��DYSYv' -� 2
LICENSE
7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
F�
USE CLASS
8 ❑ ' 1 32
LICENSE+ rar V1N.#
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO. m 33
12 SHADE IN DAMAGED AREA
FROM TO
((ABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# tGQ
VEHICLE 34
13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE
STANDING S} 8 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER
YES AGE NOHRESHOLD MET PHONE El
35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE': INITIAL36
STREETIAL
❑
16 NEn+AnnRFs.�' CITY'. ST ZIP
CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ vIN# 39
LICENSE
PLATE# rnr
20 ❑ TRAILER' TRAILER ❑ 40
PLATE# STATE PLATE# STATE
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VEHICLE
EFFECT &POLICY# I 970P - 4 44
24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM
E:l
C=DLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 06-22-24 12:27 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26F7 OI BADGE 12651 O#I',WA0171300 APPROVE
6%2E2/2024 PAGE OF F
3000-345-013(R 11118)
REPORT NO. EE88951 CASE# 24-6580 DATE AND TIME 06/21/24 21:58
OF COLLISION
4pY�
f
at
PAGE 4 OF 4