HomeMy WebLinkAbout23-9260 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9260 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 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#
cowsloN 08 - 1-- 2023 1322 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
ROUSER WAYN BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BRONSONWAYN
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254420915 0 11
30
6� LAST NAME LOH FIRSTNAME EVELYN MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 10439 SE 14TH ST CITY BELLEVUE ST WA 21P' 980047144 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CFP2383 sTArI WAurN# 5UXFA6C09P9P17977
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR. 5 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO 3 ] 34
13 3 2023 BMW X5 P4 YES❑ NO✓
REGISTERED OWNER INFO LAURENCELOH 10439 SE 14TH ST BELLEVUE WA 98004 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYBX10958240
IN EFFECT &POLICY# 9TOP
VEHICL'
15❑ EC 5 36
LALLv YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:4259618149
LAST NAME JIMENEZ CRUZ FIRST NAME IGINIO MIDDLE N
INITIAL
17❑ NEW STREETR 919 N 3
7 3RD ST CITY RENTON ST WA ZIP 980561949 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C... 08 _ 07 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS NECK AND BACK PAIN
❑ILICENSE 21❑ PLA E# C15303W TArE 41
WA VIN# 1D7HW28K86S703917 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2006 MAKE DODG MODEL DAKOTA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO IGINIO JIMENEZ CRUZ 123 FACTORY AVE N APT 2 RENTONWA98057 D:4259618149 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY 41063-73569-05 9TOP 5
IN EFFECT0(
"'LE ❑ ,.I— CITATION# CHARGE io BOTTOM
LEGALLY YES N`LJ
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88774
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9260
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) NG HOLLYN
ADDRESS&PHONE#
6240 141ST AVE SE BELLEVUE WA 980064862 2064373052 SEXi F MMDDYyry 06 - 13 - 1973
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ � 1 POS. 3 2 4 1 USE 2 CLASS !1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Ly O B
SEX' MMDDYVYV
PASSENGER [:]WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 8/12/23 1 was dispatched to the intersection of Factory Way N and BRONSON WAY N in the 100-
block due to a vehicle collision. Houser Way N, turns into Factory Way N.
Upon arrival I contacted Driver#1 who stated she was on Houser Way N headed North Bound
waiting for the red light to turn green and she noticed she was in Lane #2, a turning lane that would
take her onto Bronson Way N. Driver#1 wanted to go straight to continue North on Factory Way N in
Lane #1.
When the light turned green, it was only for the turning lanes and not the straight lane. The Straight
Lane was still red. Driver#1 said she switched lanes and went straight and then realized she had
made a mistake and was running a red light. Driver#1 drove in front of vehicle #2. Vehicle #1 was
struck by Vehicle #2. Vehicle #1 had damage to its Passenger side doors and quarter panels.
I spoke to Driver#2 who stated he was headed West on Bronson Way N and had a green light.
Driver#2 saw vehicle #1 running the red light and Driver#2 was not able to stop as Vehicle #1 drove
directly in front of Vehicle #2. Driver#2 said his neck and back hurt. Vehicle #2 had significant
damage to the front end of the vehicle.
Pictures were taken and submitted to the case. Vehicle #1 was towed by a private company.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
DESIRES SCOTT 08-13-23 12:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 8/13/2023 12:43:56 PM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED 2:15 PM TIME POLICE ARRIVED',2:20 PM
PART Ei PAGE IT]OF
REPORT NO. ED88774 CASE# ' 23-9260 DATE AND TIME 08/12/23 13:22
OF COLLISION
_H
ORY WAY N
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