HomeMy WebLinkAbout23-6906 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6906 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' UT/LITYPOLE
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 1755 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ p ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV e SHATTUCKAVE S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:9568550112 0 11
30
6 LAST NAME LLANO SOLIS FIRSTNAME OSVALDO MIDDLE 1 2 31
INITIAL
STREET ❑✓ 18703 SE MAY VALLEY RD CITy RENTON ST WA 2jp, 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
❑ DRIVER'S'' STATE MM SEX'M MELO B 02 1- 24 - 2002 2 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET 2 INJURY CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CDU9142 STATE WA VIN# 1HGCP26749A002870
10 1❑ PI ATE�
TRAILER STATE TRAILE# STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2009 HOND ACCOR DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO TEKLEMARIAMEYASU 23105126THAVESE KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO <53 4LIABILITY INSURANCEIN EFFECT &POLICV# Q
vewcLE CHARGE 5 36
LEGALLY YES❑NO CITATION# 3A0357739,3A0357739 FAIL YIELD LEFT TURN MOTOR
15❑ STANDING
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑
16 a ❑ OWNER ❑ YES 1/ NO D:2067473977
LAST NAME SAMOUN FIRST NAME SHUKRIYAH MIDDLE S
INITIAL
17❑ STREET �', 1620 BEN SON RD S#207 CITY RENTON ST WA ZIP 98055 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED ❑ 38
INTERLOCK YES�NOR INTERLOCK YEs I I NoF YES t l NOF,-/]
19 F] D IVEW #
{NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE BPW0105 TATE WA VIN# 2T3WFREV9EW115538
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2014 MAKE TOYT MODEL RAV4 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO DURYAH MOHAMATH 121..TTAVES RENTON WA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO STATE FARM 4258060-E27-47DIN STOP 5
VEwGLE YES❑ N J
C:] CITATION# CHARGE
25 to BOTTOM
LEGALLY ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED72238
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6906
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DELOSSANTOS G,ARCIA CHRISTIAN
(LAST FIRST,
ADDRESS&PHONE# D O.B.
18703 SE MAY VALLEY RD RENTON WA 98059 SEX M MMDDYyry 01 - 20 - 2002
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER RVWITNESS❑'UNIT# 1 POS 3 AIRBAG j 3 RESTR. 4 EJECT 1 USE 2 CLASS +7 COMPLAINT OF ABD.PAIN
NAME
'(LAST,FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX: MMDDYYVY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling westbound on Airport Way in the left turn lane to turn left onto southbound
Shattuck AVE S. Unit 2 was traveling eastbound on Airport Way approaching Shattuck AVE S with
the right of way. Unit 1 had a signal indicating they must yield to oncoming traffic on Airport Way if
making a left turn. Unit 1 failed to yield this right of way and initiated the left turn pulling into the path
of Unit 2. The front end of Unit 1 struck the front end of Unit 2 causing heavy damage to both
vehicles. Passenger in Unit 2 complained of side pain and was treated on scene by Renton AID.
Driver 1 advised he recently purchased the vehicle and it did not have insurance. Unit 2 towed by
Bankers Tow.
Driver 1 was cited for failure to yield the right of way to a motor vehicle when making a left turn by
initiating a left turn in front of Unit 2, which had the right of way, and was the proximate cause of the
collision. Driver 1 also cited for operating a motor vehicle without insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-17-23 07:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/21/2023 10:41:47 AM
BADGE OR ID# 10008 OR]#' ' WA0171300 TIME POLICE DISPATCHED 5:57 PM TIME POLICE ARRIVED',5:59 PM
PART I PAGE IT]OF 3�
REPORT NO. ED72238 CASE# ' 23-6906 DATE AND TIME 06/17/23 17:55
OF COLLISION
TUCK AVE 8
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