HomeMy WebLinkAbout23-7424 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-7424 2 0 7
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3❑HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cawsloN 06 - 1-- 2023 1633 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e TAYLOR AVE NW
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:2067933611 N:2065662044 0 4 30
LAST NAME GONZALEZAGUILAR FIRSTNAME MAXIMO MIDDLE p
6 INITIAL 1 1 2 31
STREET ❑✓ 2217 13TH AVE S CITy SEATTLE ST WA 7jp, 98144 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
$ DRIVERS
# STATE SEX'M MDMDD 07 - 10 - 1986 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLAY NATURE OF INJURIES 2❑
3
10❑ P1 aTES� D05128D sTArr WA urN# 1FTZR15E71PA92305
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. YRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 $ 34
13 2 2001 FORD RANGE TR DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO 1411.GONZALEZ AGUILAR 221713TH AVE S SEATTLEWA 98144 D:2067933611 N:20656620" VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vErICALLv ICLE YES CHARGE 5 36
❑NO❑ CITATION# 10 BOTTOM
15❑ LE STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068418844
16 a
LAST NAME BREAUX FIRST NAME DARYL MIDDLE I C
INITIAL
17 STREET❑ NEW ADOREss❑' 7102 45TH AVE S CITY SEATTLE ST WA ZIP 981183812 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 DRIVER'S STATE WA SEX F D.O.B. 08 _ 08 _ 1975 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS NECK PAIN
❑ 41
21❑ PLATE# BNA0419 TArE WA VIN# USE
1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GI
VEH YEAR 2014 MAKE GMC MODEL TERRAIN STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO pROGRESSIVE 942267888IN IU�"'LE
TOP
❑ ,J� CITATION# CHARGE TTOMLEGALYYES N`L J25 '
=WARD
AME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 11528 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED78405
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7424
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MOSLEY NEILANI L
(/AST FIRST,
ADDRESS&PHONE# D O.B. '
$EATTLE SEXi F MMDDYYYY 07 - 09 - 2011
PASSENGER Z WITNESS❑ UNIT# 2 SEA 3 AIRBAG 2 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
I'MUSE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. 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'
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.
S.WOODWARD 06-30-23 05:49 PM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 711112023 6:46:35 AM
BADGE OR ID# 11528 OR]# WA0171300 TIME POLICE DISPATCHED 4:36 PM TIME POLICE ARRIVED i 4:40 PM
PART I PAGE IT]OF 4�
REPORT NO. ED78405 CASE# 23-7424 OF COLLISION
06/30/23 16:33
OF CbLLI510N
NARRATIVE
On 06-30-23, 1 responded to the intersection of Taylor Ave NW and Renton Ave Ext to investigate a
reported two car collision.
On arrival, I contacted both drivers. Driv 1 only had an identification card from Mexico in the name of
Maximo D. Aguilar Gonzalez (07-10-86). He said the truck belonged to his sister and provided the
dealer temp registration for it. It returned clear and valid. He also said there was no insurance on the
truck.
Driv 2 provided all required paperwork to include a WADL in the name of Daryl C. Breaux (08-08-75).
Driv 2 said she was stopped, waiting for the light on Renton Ave Ext, waiting for traffic to clear so she
could turn left onto Hardie Ave SW. She was stopped when her vehicle was struck from behind by
Veh 2. Driv 2 said Driv 1 told her, prior to my arrival, that he was on his phone and didn't see her.
Driv 1 said he was distracted by traffic and didn't see her, as he came up to the light, failing to stop
his vehicle and striking the other vehicle on the rear bumper. When I asked him if he was on his
phone, he denied it.
Driv 2 was checked and cleared on scene by Renton FD for neck pain. Her passenger, identified as
Neilani L. Mosley (07-09-11), did not express any injuries.
I advised Driv 1 that he was going to be cited for the collision and for the other violations and that the
citation would be mailed to him.
For failing to stop and being distracted by either internal or external factors, for not having a valid
United States driver's license and for not having any insurance, I determined Driv 1 was the
proximate cause of the collision and for being in violation of the other statutes. I completed Sector
cites 3AO318969 and 970, then sent it to the prosecutor to be mailed to him.
Neither vehicle was towed.
PAGE 3 OF 4
REPORT NO. ED78405 CASE# ' 23-7424 DATE AND TIME 06/30/23 16:33
OF COLLISION
Renim Ave Ext
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Taylor AveNW
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PAGE 4 OF 4