HomeMy WebLinkAbout23-7436 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7436 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 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# ❑
COLLISION: 07 — 1—— 2023 0430 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N 3RD ST BLOCK NO. e✓ 1100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066592615 0 11
30
LAST NAME NAVARETTE-HERNANDEZ FIRST NAME JOAHAN MIDDLE
6 INITIAL 1 2 31
STREET ❑ 1171 ABERDEEN AVE NE CITY RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8 LRIIVERCENS # STATE SEX'M MDMDo 12 - 21 - 2003 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATE BAB3789 sTArI WAvIN# 1G11C5SL6FF292655
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2015 CHEV MAL/BU 4D DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ISMAEL NAVARRETE CLEMENTE 1171 ABERDEENAVE NE RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCE CO STATE FARM 4855414-S08.47 3 4
IN EFFECT &POLICY# 9TOP
vEHICE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2064984101
LAST NAME REYES-ARMENC,OL FIRST NAME OSMAN MIDDLE I D
INITIAL
17❑ STREET ❑', 8024 S 130TH ST CITY SEATTLE ST WA ZIP 981784942 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 09 _ 14 1970 0 39
LICENSE# MMDDYY
WELMET INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BUZ0745 TAre WA VIN# 1ZVBP8EMX85120342
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2011 MAKE FORD MODEL MUSTAN STYLE CP VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KURT UNTALAN 7004 S 124TH ST SEATTLE WA 98178 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 511 9714-DO2-47AIN 1GQI
VEHICLE ❑ ,.II CITATION# CHARGE
LEGALLY YES N`LJ
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED75449
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7436
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'
Vehicle #1 was traveling eastbound in the right lane of the 1100 block of N 3rd St. Vehicle #2 was
traveling eastbound in the left lane of the 1100 block of N 3rd St. Vehicle #1 merged left to change
lanes to the left lane. This caused the left side of vehicle #1 to collide with the front right corner of
vehicle #2. Based on the totality of the circumstances, it appeared the actions of vehicle #1 caused
this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 07-01-23 05:49 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 71112023 9:38:55 AM
BADGE OR ID# 11631 OR]# WA0171300 TIME POLICE DISPATCHED! 4:34 AM TIME POLICE ARRIVED 4:39 AM
PART I PAGE IT]OF 3�
REPORT NO. ED75449 CASE# 23-7436 DATE AND TIME 07/01/23 04:30
OF COLLISION
N 3rd St
lar 1w
F.N2
Not to scale EMIE=
................................. .....................................---------
momilm
Vehicle #2 Vehicle #1
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