HomeMy WebLinkAbout23-9897 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9897 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT 8 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 2257 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. e✓ 2500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2068999653 0 11
30
6 LAST NAME I CACERES VASQUEZ FIRST NAME RAUL MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 3729 S 142ND ST APT 2 CITY TUKWILA ST I WA 2jp, 98168 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ PI aT�SiI BUH9249 sTArI WAvIN#' 2HGFC2F68LH513412
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 2020 HOND CIVIC SD DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO GILBERT MAGANA SANCHEZ 3729 S 142ND STAPT 2 TUKWILA WA 98168 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3
14 LIABILITY INSURANCE� PROGRESSIVE 938964311
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 10BOTTOM 5 36
LEGALLY, res No CITATION# 3AO517810 INATTENTIVE DRIVING 5
15❑ STANDING 8 6
MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PRO
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES NO ,/ D:N
2063269595
16 a
LAST NAME KABORE FIRST NAME MAYA MIDDLE R
INITIAL
17❑ NEW ADDRE_ 1606 20STREET 1ST PL SE UNIT 9C CITY BOTHELL ST WA Zip 98012 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l No�
19 D IVEW # STATE WA ]SEX IF M.C... 09 _ 24 1999 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CEX5627 TArE 41
WA VIN# 3FA6POH72FR138998 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2015 MAKE FORD MODEL FUSION STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ABDOUL KABORE 1606201ST PL SE APT C BOTHELL WA 98012 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO INTEGONNATL.INS.CO.2016976309IN 1UQI
'E""LE ❑ ,J� CITATION# CHARGELGALYYES N`L J25
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. ED94577
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9897
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 08/27/2023 at 2301 hours I was dispatched to a collision at around the 2500 blk of NE 3rd St in
the City of Renton, King County, Washington. When I arrived, I spoke with the driver of Vehicle 2 who
told me that she was traveling Eastbound in the number 1 lane. Vehicle 2's driver stated that Vehicle
1 was in the number 2 lane and both vehicles had been brake checking each other prior to this
collision, starting on i405 NB. Vehicle 2's driver stated that Vehicle 1 attempted to merge right from
the number 2 lane to the number 1 lane and miscalculated the merge, causing Vehicle 1's rear
passenger side to collide into the front driver side of Vehicle 2. The driver of Vehicle 1 affirmed that
there had been some brake checking since the highway and that he was attempting to pass Vehicle 2
at around the 2500 blk of NE 3rd St. Vehicle 1's driver stated that he attempted to pass Vehicle 2 but
miscalculated the merge and made contact with Vehicle 2's front driver side bumper with Vehicle 1's
rear passenger side. I advised the driver of Vehicle 1 that he would receive a ticket in the mail for
failing to maintain his 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 08-28-23 12:25 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 8/31/2023 3:00:18 PM
BADGE OR ID# 12509 ORI#' WA0171300 TIME POLICE DISPATCHED! 11:01 PM TIME POLICE ARRIVED';11:02 PM
PART I PAGE IT]OF
REPORT NO. ED94577 CASE# 23-9897 DATE AND TIME 08/27/23 22:57
OF COLLISION
***NOT TO SCALE*** 2500 BLK NE 3RD ST
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