HomeMy WebLinkAbout23-8425 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8425 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL AOENC 3
HIT IT&RUN ✓ CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN ✓ CITY# ❑
GawsloN 07 - 1-- 2023 0700 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
WILLIAMS AVE S BLOCK NO. e✓ 87
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e S 2ND ST
0 1 29
MOTU '�01 VEHtOR PI CLE CYOCLE. El �ESAGE NHORE✓LD MET PHONE 1 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zlp 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YEs No✓
DRIVERS
STATE SEX D - 328 LICENSE MDYY❑ M
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 H USE 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CFF5849 sTATI WAurN# 5YJ3E1EA7NF360283
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#'
2022 TESL MODEL SD ❑ FROM
34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO ✓ YES NO✓
REGISTERED.WNERINFO OINGIL HAILE 20402106TH AVE SE APT S101 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ ABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICV# 9TOP
vEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.R R 8 6
UNIT VE IOOR Z CYCLE ❑ PEDESTRIAN ❑ OWNER ES❑ DYES✓ NO OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
17 1-1STREET
CITY ST ZIP 37
NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NoF� YES❑NO
19 LLIICENS RIVEWS# STATE I SEX U MMDDYY —=_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT '1 USE 9 CLASS 0 ❑
❑21❑ PLATE# BPN1493 TATE WA VIN# 2(BKFLREKOC6237362 41
4
42
22 [TRAILER TILER
❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2012 MAKE GMC MODEL TERRAIN STYLE (��' VEHICLE TOWED TO BLIN TOWEDey GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO NURIA VASQUEZ RAMIREZ 87 WILLIAMS AVE S RENTON WA 98057 D:2064308483 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 925723704IN 1❑ ,J� CITATION# CHARGE
25 5�, �
YES N`L J
7JACOB
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26WEBER 12532 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84863
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8425
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'
On 07/23/2023 at approximately 0724 hours I was dispatched to 87 Williams Ave S for a report of a
hit and run which ah doccured 20 minutes prior. I arrived on scene and located Vehicle 2. 1 spoke with
the RO Nuria Vasquez Ramirez DOB 01/03/88 who advised she had been inside her residence when
a neighbor advised her vehcile had been hit. The neighbor got the plate of Vehicle 1, whih was being
driven by a younger black female in her 20's. Vehicle 1 struck Vehicle 2 in the rear, pushing it into the
rear of Vehicle 3 owned by Alaina St. Clair DOB 12/15/1989. Vehicle 1 then backed up and sped off. I
located Alaina and helped her exchange infomation with the owner of Vehicle 2. Both parties advised
they would be willing to press charges for hit and run, but neither had observed the driver.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 07-23-23 05:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:25:35 PM
BADGE OR ID# 12532 ORI#' i WA0171300 TIME POLICE DISPATCHED; 7:24 AM TIME POLICE ARRIVED]7:41 AM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. ED84863
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-8425
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL-
PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN :. YES IN
1 4 29
LAST NAME : UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET 30
NEW AnnRFS CITY ST ZIP
6 1
CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES NO NTERLOCK YES❑N0� vES N
DRIVER'S STATE I SEX U M��DYSYv' -� 2
LICENSE
7
ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES
F�
USE CLASS
8 ❑ 1 32
LICENSE BYT4691 TAr WA VIN# 2HGFC2F54JH546704
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 O O VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1C P FROM TO
2018 HOND CIVIC SD DAMAGE YES NO YES NO
REGISTERED OWNER INFOALAINA ST CLAIR 110 WILLIAMS AVE S RENTON WA 98057 D:4258913874 m 33
12 � SHADE IN DAMAGED AREA
7 j FROM TO
LIABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# t 9 101?
EHILLE o BarroM 34
13 LEGALLY YES N001
CITATION# CHARGE
STANDING �} 8 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15F� I LAST NAME FIRST NAME INIMIDDLETIAL ❑ 36
STREET 16 NEW
ETET".� CITY ST ZIP
AnnRCDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
NTERLUCK YES NO NTERLOCK YES NO 'YES NO ❑
17 5 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER' TRAILER ❑ 40
PLATE# STATE PLATE# STATE
21 ❑ [441
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VEHICLE
EFFECT &POLICY# I 970P - 4 44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeGAlly
E:l
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 07-23-23 05:05 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 12532 O#I',WA0171300 SCOTT 7131/2023 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. ED84863 CASE# 23-8425 DATE AND TIME 07/23/23 07:00
OF COLLISION
co
ui
N
U7
Q
S^�
87 WILLIAMS AVE S
2
1
S 2Np ST
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