HomeMy WebLinkAbout23-6996 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED73317 170
27
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-6996 2 177
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION 06 — 09 — 2023 1503 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 120 00 FEET e S ❑ E e UNION AVE NE❑
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4252196029 0 11
30
6� LAST NAME MASIEL FIRSTNAME ANTONIO MIDDLE D 1 1 2 31
INITIAL
STREET El 12750 SE 168TH ST CITY RENTON ST WA ZIP 98058 2
NEW ADDRESS
]❑ 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 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 PI ATE 14 B WP8993 sTATe WA V N# 1 FMCU03Z18KA90251
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 7 34
13 2 2008 FORD ESCAPE UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ANTONIO CADENA TORRES 12150 SE 168TH ST RENTON WA 98058 D:2064878348 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 506 7789-F30.47 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 3AO450682 NO VALID OPER LICENSE WITH <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD M PHO7D.2
E
16 a ET
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D.2068223603
LAST NAME CRUZ FIRST NAME ANNA MIDDLE S
INITIAL
17❑ STREET SS❑' 10075 S
NEW ADDREE 213TH PL CITY l KENT ST WA ZIP 98031 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYES❑No� INTERLOCK yEs❑NOF YES❑NOF,/
19 DRIVER #
❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BOT1050 TATE 41
WA vIN# JA4AZ3A35HZ046008 1
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
Gov HI
VEH YEAR 2017 MAKE �lijJ'j-S MODEL OUTLAN STYLE —FEHICLE
TOWED NOO✓ BLIN TOWED BY 44
fj
YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO pROGRESSIVE 900482588IN STOP 5
VEHICLE YES[:] NC[:]I CITATION# CHARGE io BOTTOM
LEGALLY
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MATTHEW TRAINO 12811 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73317
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6996
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) CRUZ PAUL
ADDRESS&PHONE#
10075 SE 213TH PL KENT WA 98031 SEX M MMDDYyry 04 - 02 - 2016
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. 9 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 06/09/2023 1 was dispatched to an accident at the referenced time and location. Unit#1 was
leaving the parking lot at 4020 NE 4th ST to turn right onto NE 4th ST, when the vehicle pulled in front
of Unit#2, which had the right of way. U-2 collided with U-1, causing moderate damage to both
vehicles.
The driver of Unit#1, identified by his WAID as Antonio D. Masiel (11/20/2004), stated he was leaving
the parking lot to head westbound on NE 4th ST. Masiel was driving his fathers 2008 Ford Escape
(WA Plate BWP8993). He said there was a bus stopped before the driveway, and he could not see
around it. According to Masiel, he decided to pull out onto NE 4th, when Unit#2 collided with his
vehicle. Masiel said that he did not have a drivers license, only a drivers permit. It should be noted
that he was the only subject in the vehicle. He reported no injuries.
The driver of Unit#2, identified by her WADOL as Anna S. Cruz (08/30/1989), stated she was
heading westbound in the 4000 block of NE 4th ST when she observed U-1 pull in front of her. Cruz
stated she applied her brakes but was unable to stop before the collision occurred. Cruz was driving
her 2017 Mitsubishi Outlander, WA Plate BOT1050. Her son, identified as Paul Cruz (04/02/2016),
was in the right rear passenger seat. Cruz and her son reported no injuries.
Both vehicles sustained moderate damage in the collision.
Masiel was issued a notice of infraction under RCW 46.20.015 No Valid Operators License with ID.
The infraction was explained to him, he said he had no questions.
N/F.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MATTHEW TRAINO 06-09-23 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 6/24/2023 1:10:37 PM
BADGE OR ID# 12811 ORI# WA0171300 TIME POLICE DISPATCHED; 3:07 PM TIME POLICE ARRIVED';3:10 PM
PART I PAGE IT]OF
REPORT NO. ED73317 CASE# 23-6996 DATE AND TIME 06/09/23 15:03
OF COLLISION
Not plc Scale P.,k,W Lt-4020 NE 4th ST
Scene NO Obs.r-d 4!
al
...........
P-1 of lmpt NE 41h ST
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