HomeMy WebLinkAbout23-7431 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-7431 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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#
cawsloN 06 - 1-- 2023 2330 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 9TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a K/RKLAND AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:3068480295 0 81
30
6❑ LAST NAME DIAZ LEAL GUADARRAMA FIRST NAME RENE MIDDLE
INITIAL 1 F 2 31
STREET ❑ 906 GLENNWOOD AVE NE APT 3 CITY RENTON ST WA ZIP 980563064 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ I INTERLOCK YES NO YES R NO
8❑ LICENS
DRIVER # STATE WA SEX'M MMDDYY 10 — 12 — 1992 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
,OF
Pi ATNES# B408932 sTAr WAV N# 1 GCNCPEH2E2156399
TRAILER STATE TRAILER STATE11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 0 0 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2014 CHEV SILVER DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO WESTERNST4TES FIRE PROTECTIO 14690 NE 95TH ST STE 101 REDMOND WA 98052 D:3068480295 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 00516533.0 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe 1 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255476541
16 a
LAST NAME BANISTER FIRST NAME STEFANI MIDDLE M
INITIAL
17 STREET❑ NEW ADDREss❑' 691 SHELTON AVE NE CITY RENTON ST WA ZIP 980563907 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.O.B. 08 _ 15 _ 1966 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLATE# BOX2018 TArE WA VIN 1t JF1 GE61648H505998 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE SUBA MODEL ►MPREZA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO STEFANI BANISTER 691 SHELTON AVE NE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 934764724IN I 1 0( STOP 5
vE"'LE CITATION# CHARGE
i o BOTTOM
LEGALLY YES Nu
25❑ J a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76225
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7431
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'
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.
JAKE GALL 07-01-23 12:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 7/3/2023 6:35:57 PM
BADGE OR ID# 12617 OR]#' WA0171300 TIME POLICE DISPATCHED 11:36 PM TIME POLICE ARRIVED',11:38 PM
PART I PAGE IT]OF 4�
REPORT NO. ED76225 CASE# 23-7431 OF COLLISION
06/30/23 23:30
OF CbLLI510N
NARRATIVE
*This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. *
The following occurred within the City of Renton, King County WA and was recorded on my body
worn camera.
ON 06/30/2023 at around 2336 hours, I was dispatched to a two-vehicle collision located at the
intersection of Kirkland Ave NE and NE 9th ST.
I arrived on scene and spoke with Driver 1 (driving the Chevrolet truck). There was minor damage to
the front driver side quarter panel and the vehicle appeared drivable. Driver 1 provided me all the
necessary information required.
Driver 2 had pulled into a church parking lot just north of the intersection. Vehicle 2 had major driver
side front-end damage and did not appear drivable. Driver 2 provided me with all the necessary
information.
Driver 2 mentioned that she was stopped at the stop sign at the intersection on NE 9th St and
Kirkland Ave NE. Vehicle 2 was facing East and was preparing to turn South on Kirkland Ave NE. As
driver 2 was still stopped, vehicle 1 was driving North on Kirkland Ave NE, turning West onto NE 9th
St. Driver 2 stated that Driver 1 turned to sharp and ended up in her lane. This caused vehicle 1's
driver side wheel/quarter panel to impact vehicle 2's center/quarter panel.
Driver 1 spoke limited English, so he was unable to go into detail about what happen. Driver 1
Mentioned that vehicle 2 was stopped over the stop line, causing him to impact vehicle 2.
Vehicle 2 was left in the private parking lot. Vehicle 1 was left on scene safely off the roadway for the
driver to move later.
I provided Driver 2 a ride to her residence which was .8 miles away.
I provided both drivers with an exchange of insurance information as well as the case number.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Gall/12617
07/01/23 at 0039 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. ED76225 CASE# 23-7431 DATE AND TIME 06/30/23 23:30
OF COLLISION
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