HomeMy WebLinkAbout23-4765 (2) POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED71266 170
27
COLLISION REP FIT 1591971
CASE 23-4765 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 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 04 - 1-- 2023 2012 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 2001. 00 FEET MILES e S B W e S 3RD ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067080683 0 11
30
6� LAST NAME TRAYLOR FIRSTNAME KIARA MIDDLE L 1 1 2 31
INITIAL
STREET 01 2137 SE 8TH PL CITY RENTON ST WA 21p 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE 098MSA STATE OR VN# 3N1CP5CV5ML477208
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2021 NISS SENTRA SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO EAN HOLDINGS LLC 20400 SW TETON AVE TUALATINOR97062 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ENTERPRISE LEASING UNKNOWN 4
IN EFFECT &POLICY# 9TOP
VEHICLe CHARGE 1 5 36
LECALLv ve5❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM1/ THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO D:2068546006
16 a
LAST NAME CABRERA LEON FIRST NAME ROBERTO MIDDLE
INITIAL
17 STREET I❑ s❑' 5325 NE SUNSET BLVD TRLR 3 CITY RENTON ST WA ZIP 98055 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 LICENSE# STATE I WA SEX U M D.C.B. 04 09 _ 1974 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# BEP4476 TATE WA VIN 41
KMHEC4A43DA094618 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE HYUN MODEL SONATA STYLE SO VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ROBERTO CABRERA LEON 5325 NE SUNSET BLVD TRLR 3 RENTON WA 98059 D:2068546006 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 914940922IN 1UR'E""LE
❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 4553 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED71266
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4765
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WINTERS DEONDRE D
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
25020 45TH PL S,APT F302 KENT WA 98032 2068861569 SEX M MMDDYyry 10 - 21 - 1995
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) TAYLOR TRAVIS A
ADDRESS&PHONE# D O B- 05 1128 SW SPOKANE SEATTLE WA 98134 5095969371 SEX M 450B - 25 - 1990
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[:]WITNESS POS. USE CLASS
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 was driving NB in the 300 block of Rainier AVE S in the curb lane. Unit 1 was driving NB on
Rainier AVE S in the number 2 lane and attempt to make a right lane change or turn striking Unit 2.
Witness Taylor confirmed the account of the collision. There were no obvious injuries. This occurred
in the City of Renton, County of King.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 05-07-23 12:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 611812023 5:28:52 PM
BADGE OR ID# 4553 OR]# WA0171300 TIME POLICE DISPATCHED; 8:12 Pry] TIME POLICE ARRIVED';8:14 PM
PART I PAGE IT]OF 3�
REPORT NO. ED71266 CASE# 23-4765 DATE AND TIME 04/27/23 20:12
OF COLLISION
W
53RDST
I aS
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