HomeMy WebLinkAbout23-7247 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED74654 170
27
COLLISION REP FIT 1591971
CASE 23-7247 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL AOENC 3
HIT IT&8 RUN � CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 06 - 1-- 2023 1615 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAIN AVE S BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S 3RD ST
0 3 29
MOTU '�01 VEHtOCLEPI PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 0 3 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO INTERLOCK YES NO YES No
$❑ LICIENSE# STATE SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLA Y 0 NATURE OF INJURIES z❑
3
10[1 PI P1 ATE 14 CFG4848 sTAT WA u N#' JN8A218W39W137179
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# Rom ro
TRLR. TRLR 5 2 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 2 34
13 2 2009 NISS MURAN SW DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO BELLANIRA FARFAN ALCAZAR 3926 NE 12TH ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VE-LE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7023340913
16 a
LAST NAME CASH FIRSTNAME LARRY MIDDLE D
INITIAL
17❑ STREET NEW ADDRESS❑' 2725 S NELLIS BLVD UNIT 2026 CITY LAS VEGAS ST NV ZIP 89121 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DRIVERS#
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
❑ILICENSE 21❑ PLA E# BMZ1558 TATE 41
TN VIN# 3FA6POLUSJR262625 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE FORD MODEL FUSION STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HERTZ 1459 INTERSTATE DR STE D COOKEVILLE TN 38501 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSURANCE
#E CO USAA 028022482C71015IN 1UQI
'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED74654
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7247
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CORBIN GLENDA L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
2725 S NELLIS BLVD UNIT 2062 LAS VEGAS NV 89121 7023010356 SEXi F MMDDuyry 08 - 21 - 1963
PASSENGER Z WITNESS❑ UNIT# 2 PoS 1 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) DILLARD TRACY R
ADDRESS&PHONE# D O 8
2201 SE MAPLE VALLEY HWY#168 RENTON WA 98057 4257610819 SEX' M MMDDuvvv 09 - 16 - 1946
PASSENGER []WITNESSZ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Contacted driver 2 Cash at 200 Mill Ave S; Unit 1 had fled after collision, and Cash gave me the
following account. Unit 2 was n/b on Main Ave S in right curb lane, unit 1 n/b on Main Ave S in second
lane. Both vehicles turned right at S 3rd St; unit 1 cut into curb lane, and unit 1 right body impacted
unit 2 left front corner. Unit 1 failed to stop, and left scene. Witness Dillard was a pedestrian who
heard sound of collision and then saw both vehicles situated as Cash described. Dillard watched Unit
1 flee, and waited with Cash until I arrived.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-26-23 06:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 612812023 4:19:36 PM
BADGE OR ID# 5738 OR]# WA0171300 TIME POLICE DISPATCHED', 4:23 PM TIME POLICE ARRIVED 4:32 PM
PART I PAGE 2�OF❑
REPORT NO. ED74654 CASE# ' 23-7247 DATE AND TIME 06/26/23 16:15
OF COLLISION
Unit 2
co
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