HomeMy WebLinkAbout23-8860 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8860 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 08 - 1-- 2023 1500 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
SW 7TH MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2063564579 0 81
30
6� LAST NAME AYALEW FIRSTNAME TEWODROS MIDDLE K 1 2 31
INITIAL
STREET ❑ 3512 S 180TH ST APT E10 CITY SEATAC ST WA 2jp, 981884312 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 06 - 03 - 1975 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� 92670C sTATe WAurN# 5FYH7YU059C036317
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 2009 MAKE NEW MODEL BUS STYLE BU VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE J 9 34
DAMAGE YES NO YES❑ NO✓
13❑ REGISTERED OWNER INFO ,KING COUNTY.SEATTLEWA 98188 D:2063564579 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO KING COUNTYMETRO. 3 4
IN EFFECT &POLICY# 9TOP
VEwc LEGALLvLE 5 36
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHOO NE
UNITa2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ R4252210142
16 a
LAST NAME BIRCH FIRST NAME ALEXANDER MIDDLE I E
INITIAL
17❑ STREET ❑', 15817 SE 128TH ST CITY RENTON ST WA ZIP 980598521 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 LDI IVEW # STATE WA SEX M M D.O.B. 11 20 _ 1986 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE AFK2381 TATE WA VIN# 2C1MR2261S6783082
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 1995 MAKE CHEV MODEL GEOMET STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO HENRY MARTIN 15817 SE 128TH ST RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2010237767 IG
STOP 5
IN EFFECT
vE""LE CITATION# CHARGE BOTTOM
LEGALLY YES Nu
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED89737
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8860
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GARCIAHERNANDEZ ELYA
(LAST FIRST,
ADDRESS&PHONE# D.0
.B.
4702 DAVIS AVE S QQ102 RENTON WA 981082956 2065350458 SEX F MMDDvyry 03 - 31 - 1996
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER WITNESS❑1 UNIT# 1 POS. 11 AIRBAG 2 RESTR. 1 EJECT 1 USE CLASS 7 BACK
NAME
(LAST,FIRST,MIDDLE INITIAL) REYES DOMINGUEZ MELBA N
ADDRESS&PHONE# Ly O B
12311 SE 160TH ST RENTON WA 9805847214256236595 SEX F MMDDvvYv 01 _ 02 _ 1973
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 10 AIRBAG 2 RESTR. 1 EJECT 1 USE CLASS 6 L.RIBS,ARM
NAME
(LAST FIRST,MIDDLE INITIAL) COLLINS LAUREN M
ADDREss&PHONE# 4219 S OTHELLO ST APT 364 SEA TTLE WA 981183894 2063517103 SEX F D.O.B. 01
MMDDYYYY
PASSENGER WITNESS UNIT# ! 1 SEAT 10 AIRBAG 2 RESTR. 1 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES
POS. USE CLASS ARM
NARRATIVE'
On 080323 1 responded to a 2-vehicle injury/non-blocking collision that occurred on SW 7th at Rainier
Ave S.
I contacted the driver of unit 2 who told me they were stopped on SW 7th in the left-turn only lane to
northbound Rainier Ave S when they were rear-ended by unit 1 at a low rate of speed. The driver of
unit 2 was not injured and there was no visible damage to the vehicle.
I contacted the driver of unit 1 who told me he hit the rear-bumper of unit 2. Driver believes his speed
was around 5mph. There was no visible damage on unit 1. There were 3 passengers aboard unit 1
(King County Bus) who stated they were injured due to the incident. All three were treated by Renton
Fire. One passenger was transported to Valley Medical for further observation for a complaint of arm
pain.
But not for the action of UNIT 1 DRIVER the result would not have happened.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Seat Position (Passenger MELBA REYES DOMINGUEZ): LEFT SIDE SEAT
Seat Position (Passenger LAUREN COLLINS): RIGHT SIDE SEAT
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 08-14-23 01:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/16/2023 8:54:47 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 3:00 PM TIME POLICE ARRIVED 3:10 PM
PART I PAGE IT]OF
REPORT NO. ED89737 CASE# ' 23-8860 DATE AND TIME 08/03/23 15:00
OF COLLISION
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