HomeMy WebLinkAbout23-9780 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9780 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 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 0809 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ,❑ FEET ❑ S ❑ W e S GRADYWAY
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2064320537 0 4 30
6� LAST NAME SANTIANO FIRSTNAME JERICA MIDDLE V 1 1 2 31
INITIAL
STREET ❑ 8409 S 117TH ST CITY SEATTLE ST WA 21p, 981784015 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3❑
10❑ PI ATE 14 BLY5825 JBTATIJ WA u N# 19UUA56862A028375
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2002 MAKE ACUR MODEL 3.2TL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 5 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO JERICA SANTIAN08409 S 117TH ST SEATTLE WA 98178 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
2 3
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
ve'C CHARGE 10 BOTTOM 36
LEGALLY YES No CITATION# 3A0387742,3A0387742 OP MOT VEH W/OUT INSURANCE,
15❑ NDING 8 6
MOTOR PEDAL- .PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4253774618
16 a
LAST NAME LARIOS FIRST NAME CARLOS MIDDLE IN
INITIAL
17❑ STREET ❑', 22519 SE BAIN RD CITY MAPLE VALLEY ST WA ZIP 980386521 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs❑NOF YES
❑No❑
19 F] DRIVER'S STATE I WA SEX M I D.C.B. 11 08 _ 1998 El 39
LICENSE# MMDDYY
WELMET INJURY NATURE OF INJURIES 4O
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I WSU740G TAre I WA VIN1t 3TMDZ58N4PM148155
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE TOYT MODEL TACOMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CARLOS LARIOS 22519SE BAIN RD MAPLE VALLEY WA 98038 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PEMCO INS CA 2087396IN 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97754
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9780
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 082523 1 responded to a 2-vehicle non-injury/non-blocking collision that occurred at S Grady Way
and Rainier Ave S.
I contacted the driver of unit 2 who told me they were making a left turn from westbound S Grady Way
to southbound 167 with a solid green arrow when they were involved in a collision with unit 1. The
driver of unit 2 was not injured. I observed damage to the front passenger side bumper and quarter
panel of unit 2.
1 contacted the driver of unit 1, identified as Jerica V Santiano (dob 05/17/90) via her WA DL.
Santanio says she was exiting northbound 167 through S Grady at Rainier Ave S when she was
involved in a collision with unit 2. Santanio says she entered the intersection when her northbound
traffic had a red light. Santanio was not injured. I observed rear passenger bumper and quarter
panel damage to unit 1.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Santanio via SECTOR under RCW 46.61.050-Failure to Obey Traffic Signal
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 08-25-23 11:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 911112023 10:22:59 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 8:40 AM TIME POLICE ARRIVED 8:45 AM
PART I PAGE IT]OF 3�
REPORT NO. ED97754 CASE# ' 23-9780 DATE AND TIME 08/25/23 08:09
OF COLLISION
Rainier Ave. S
N
S Grady Way
SW Grady Way Y,
HWY 167'
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