HomeMy WebLinkAbout23-6876 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED74451 170
27
COLLISION REP FIT 1591971
CASE 23-6876 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
COLLISION: O6 - 1-- 2023 1556 17 ❑. S 8 W Li OF e 1070 3
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 100
4a 9❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW V/CTOR/A ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:3608907938 0 11
30
6� LAST NAME ROCHA-BARRIGA FIRSTNAME ANGEL MIDDLE 1 2 31
INITIAL
STREET ❑, 15011 SE 179TH ST 14C CITY RENTON ST WA Zlp' 98058 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 SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� C71165N sTArI WAVIN# 1GCVKSECXE2133009
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34
13 2 2014 CHEV SILVER PK DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� LIABILITY INSURANCE INSURANCECO STATE FARM 4470621-B11.47 4
IN EFFECT &POLICY# 1 9TOP
VawcLe CHARGE 5 36
ALLY YES❑NO CITATION# 3AO423959 PROH/IMPROPER TURN o aorro6
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:6618891779
16 2
LAST NAME MONGE FIRST NAME VANESSA MIDDLE
INITIAL
17❑ STREET ❑', 24124 SULTZEAVE CITY' MARICOPA ST CA ZIP 93252 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 8TMR486 TAre CA vINIt 1C4HJXDNOMW589374
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2021 MAKE JEEP MODEL WRANGL STYLE VT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04533835882IN STOP
g
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED74451
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6876
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'
Unit 1 (Silverado) was turning right from EB SW Victoria St to SB Rainier Ave S, into lane two. Unit 2
(Jeep) was SB Rainier Ave S in lane 1. Unit 1 driver Rocha-Barrigo told me that his large truck
appeared too close to NB traffic, and he tried to correct right. Silverado's right side hit Jeep's left rear
corner, shattering Jeep left taillight assembly and scraping right side of Silverado. Rocha-Barrigo will
be ticketed for improper turn.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-16-23 05:20 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS solo 1 612812023 7:16:57 AM
BADGE OR ID# 5738 OR]# WA0171300 TIME POLICE DISPATCHED; 4:08 PM TIME POLICE ARRIVED f 4:12 PM
PART I PAGE IT]OF 3�
REPORT NO. ED7 4] CASE# 2y6 7 AT m°M\ 0 d @23 ]e5
« : COLLISION <
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