HomeMy WebLinkAbout23-9689 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-9689 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 08 - 1-- 2023 1746 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 13700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066377727 0 7 30
6� LAST NAME NARIYA FIRSTNAME PHINIESA MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 24511 146TH PL SE CITY KENT ST WA ZIP, 98042 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'F MM DAY' 09 1- 07 - 1992 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ pl ATFBit 768YGY sTATe WA urN# 2HGFA16558H350507
TRAILER STATE TRAILER STATE
11 4 5 PLATE# PLATE# ROM TO
TRLR. TRLR 7 3 33
12 4 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34
13 4 2008 HOND CIVIC SD DAMAGE YES NO YES[:] No
No
REGISTERED OWNER INFO DHA.NARIYA.511146TH PL SE KENT WA 98042 VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE ALLSTATE 964527667
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 10BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2086044606
16 a
LAST NAME TREJO FIRST NAME GILBERTO MIDDLE B
INITIAL
17 STREET❑ NEW ADDREss❑' 15360 146TH PL SE CITY RENTON ST WA ZIP 98058 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYEs❑No� INTERLOCK YEsF-j No� YEs NOF
19 LDICENSIVEW # STATE WA SEX M MMDDYY 01 11 1989 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR g EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLATE# 41
C78636R TATE WA vIN1 1FTEW1EP7FKF10374 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2015 MAKE FORD MODEL F150 STYLE PK DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 987180361IN 1 GD
LEGAL25
LY YES Nu
❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED94574
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9689
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TREJO AMANI N
(/AST FIRST,
ADDRESS&PHONE# D O.B. '
15360 146TH PL SE RENTON WA 98058 SEX M MMDDYyvv 08 - 14 - 2018
PASSENGER Z WITNESS UNIT# 2 POS. 'I y AIRBAG 2 RESTR. 9 EJECT ? 1 H USE 2 1 INJURY CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) TREJO NIA N
ADDRESS&PHONE# D O B
15360 146TH PL SE RENTON WA 98058 SEX' F MMaovvvv 05 _ 05 _ 2022
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 2 RESTR. 11 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 08/22/2023 at 1821 hours I was dispatched to a collision at around the 13700 blk of Maple Valley
Highway in the City of Renton, King County, Washington. When I arrived, I met with the drivers of
both vehicles. The driver of Vehicle 1 stated that she was traveling Eastbound in the number 1 lane
behind Vehicle 2. Driver 1 stated that she saw that traffic was backed up and was moving forward
with the flow of traffic. Driver 1 stated that she did not see the brake lights of Vehicle 2 and did not
have time to stop an avoid a collision. Driver 1 stated that the front end of Vehicle 1 collided with the
rear bumper of Vehicle 2. 1 spoke with Driver 2 and he stated that he was at a stop in traffic and felt
the front Vehicle 1 collide with the rear of Vehicle 2. Driver 2 stated that he was also traveling
Eastbound in the number 1 lane.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 08-22-23 07:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 8/31/2023 3:00:40 PM
BADGE OR ID# 12509 ORI#' WA0171300 TIME POLICE DISPATCHED', 6:21 PM TIME POLICE ARRIVED]6:30 PM
PART I PAGE IT]OF
REPORT NO. ED94574 CASE# 23-9689 DATE AND TIME 08/22/23 17:46
OF COLLISION
13700 Bik Maple Valley Highway
o.
—NOT TO SCALE'
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