HomeMy WebLinkAbout23-6396 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-6396 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.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# ❑
cowsloN 06 - 1-- 2023 1500 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HARRINGTON AVE NE BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2064304894 1 4 30
6� LAST NAME SANTAMARIA FIRSTNAME HEATHER MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 3223 S 160TH ST APT 24 CITY SEATAC ST WA ZIP' 981885621 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10� PI ATE B9444C sTATI WA urN#' 1 BABNBSAOJF339149
TRAILER STATE TRAILER STATE
11 2 0 PLATE# PLATE# Rom ro
TRLR. TRLR 5 1 33
12 0 0 VIN# VIN#
2018 BLUE T3 RE nIG FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO❑BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO ✓ YES[:] NO✓
13 REGISTERED OWNER INFO RENTONSCHOOLDISTRICT300SW7THST RENTONWA98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO SIAWSIAW222334033 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,DIING 8 7 6
UNIT 02 VEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS# STATE SEX U MMDDYY —�_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
21❑ LICENSE I BPX0354 TATe WA VIN1t JH4KA9656VC800044
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
YEAR 1997 MAKE ACUR MODEL 3.5RL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
VEH
L4❑ DAMAGE YES NO,� YES NO✓
REGISTERED OWNER INFO ARTURO SOLIS CERVANTES 2812 NE 7TH ST RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO MIDDLESEXIN STOP 5
VE""LE ❑ N`LJ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED70711
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6396
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 060523 1 responded to a 2-vehicle non-injury/non-blocking collision at Harrington Ave NE and 8th
St.
I contacted the driver of unit 1 who told me they were traveling northbound on Harrington Ave Ne
when they collided with a parked vehicle on the eastside of the roadway. The parked vehicle was
unoccupied at the time. No injuries to the driver of unit 1.
I contacted the owner of unit 2 who confirmed the vehicle was unoccupied. Unit 2 was legally parked
at the time it was struck by unit 1.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-06-23 11:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 6/16/2023 8:29:50 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 3:00 PM TIME POLICE ARRIVED 3:15 PM
PART I PAGE IT]OF
REPORT NO. ED70711 CASE# ' 23-6396 DATE AND TIME 06/05/23 15:00
OF COLLISION
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