HomeMy WebLinkAbout23-6124 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6124 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 05 - 1-- 2023 0946 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FMILES EET e S ❑ E e RAINIER AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067869039 0 11
30
5� LAST NAME LICAVOLI FIRSTNAME SALVITO MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 2815 60TH STREET CT NW I CITY GIG HARBOR ST WA 2jp, 983351321 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9� P1 AT 14 CGF4132 STATE WA VIN# 3VWC576U1KM184157
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM ro
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2019 YOLK JETTA 4D DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER WFO SALVITO LICAVOLI 281560TH STREETCTNW GIG HARBOR WA 98335 D:2067869039 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO ESURANCEPAWA-0099268108 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:2069739349
16 a
LAST NAME FISHER FIRST NAME DEMETRIUS MIDDLE I D
INITIAL
17 STREET I❑ 19223 89TH AVE E CITY GRAHAM ST WA ZIP 983386482 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 DRIVER'S STATE WA SEX M D.C... 04 03 _ 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BAH3057 TATE 41
WA VIN# 1G6DG5E56C0121928 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2012 MAKE CADI MODEL CTS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DEMETRIUS FISHER 1922389TH AVE EGRAHAMWA98338 D:2069739349 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04525206910IN
VEHICLE ❑ ,.I—I CITATION# CHARGEC�Ql
LEGALLY YES N`E]
25 —TA
s � e
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED66290
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6124
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 05-30-23 10:52 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 6/2/2023 11:49:57 AM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 10:02 AM TIME POLICE ARRIVED 10:06 AM
PART I PAGE IT]OF 4�
REPORT NO. ED66290 CASE# 23-6124 OF COLLISION
05/30/23 09:46
OF CbLLI510N
NARRATIVE
23-6124
On 05/30/2023 at approximately 1002 hours, I, Officer Lantagne, responded to a non-blocking, non-
injury collision near the intersection of S 2nd ST and Rainier AVE S, which is located in the City of
Renton, County of King, and the State of Washington. I responded in my fully marked police vehicle,
wearing my patrol uniform.
I arrived on scene and observed Unit#1, a 2019 Volkswagen Jetta with license plates CGF4132
issued out of Washington State, and Unit#2, a 2012 Cadillac CTS with license plates BAH3057,
parked in the Safeway parking lot. I was advised there were no injuries.
I contacted the driver of Unit#1, Salvito Licavoli (DOB 03/02/1983), who told me the following:
Licavoli was driving westbound on S 2nd ST in the 200 block. Licavoli changed lanes from the inside
lane to the left curb lane and the left side of his vehicle hit the front right corner of Unit#2 which was
in his blind spot.
I contacted the driver of Unit#2, Demetrius D. Fisher (DOB 04/03/1979), who told me the following:
Fisher was driving westbound on S 2nd ST in the left curb lane. As Fisher was nearing the
intersection at Rainier AVE S, the vehicle to the right of his changed lanes and struck the right front
side of his vehicle.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant damage to the driver side doors which were
crumpled in and scraped. Unit#2 had damage to the right front bumper which was scraped and
cracked in several places. The roadway the vehicles were driving on was a four lane, one-way
westbound street.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Licavoli and Fisher.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1037 hours on 05/30/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EU86280 CASE# 23-8124 DATE AND TIME 05/30/2300:48