HomeMy WebLinkAbout23-10126 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED95741 170
27
COLLISION REP FIT 1591971
CASE 23-10126 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
cowsloN 09 - 01 - 2023 2306 17 �. S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e --- ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e DAMS AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2065804676 0 11
30
6❑ LAST NAME SANCHEZ FIRSTNAME JAZMIN MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 862 SW 135TH ST APT 2 CITY BURIEN ST WA 2jp, 98146 1 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 08 1- 22 - 1992 2 32
9 ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BKU7193 sTArI WAvIN# 1HGCR2F39HA213701
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 HOND ACCOR 4C DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JAZMIN SANCHEZ GARCIA 862 SW 135TH ST APT 2 BURIEN WA 98146 D:2065804676 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# m
LEGA LE CHARGE 5 36
LEcnLLv res❑NO❑ CITATION#
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:2532024338
16 a
LAST NAME JOHNSON FIRST NAME JAZZMEAYNE MIDDLE K
INITIAL
17 STREET IST NE APT A2 CITY' AUBURN ST' WA ZIP 98002 4❑ 37
NEW ADDREs�' 553 8TH
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] LDI IVER # STATE WA ]SEX IF M D.C.B. 12 _ 21 1997 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# A6580284 TArE 41
WA VIN# 1FMSK8DH3PGB42857 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE FORD MODEL EXPLORE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO WASHINGTON SECURITY SERVICES 4025 DELRIDGE WAY SW SEATTLE WA 98106 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE 8 PORGY#E CO WASHINGTON SECURITY 10006724971231 �IN EFFECT
'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
N AAH GIRELLO 12607 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED95741
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10126
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) OKULLU OCHORA M
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
401 KENYON ST NW APT Q7 OLYMPIA WA 98502 SEX M MMDDYyry 04 - 04 - 2000
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE of INJURIES
✓❑ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NOAH GIRELLO 09-02-23 03:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 9/4/2023 6:55:26 PM
BADGE OR ID# 12607 ORI# WA0171300 TIME POLICE DISPATCHED 11:06 PM TIME POLICE ARRIVED',11:11 PM
PART Ei PAGE IT]OF 4]
TIME
REPORT NO. ED95741 CASE# 23-10126 OF COLLISION09/01/23 23:06
NARRATIVE
23-10126
At about 2311 hours on 09/01/2023 1 responded to a motor vehicle accident, S 43rd ST/ Davis Ave S,
in the city of Renton, King County, Washington. I was advised this was a two-car collision with no
injuries and the vehicles were blocking east bound traffic on S 43rd ST.
Upon my arrival the officer first on scene had already checked with all occupants and confirmed there
were no injuries and was able to have both vehicles move out of the roadway. I would then speak to
both drivers and get their sides of the story.
The following is a summary of what unit 1 told me happened. Unit 1 said she was traveling east
bound on S 43rd ST in the #2 lane of 3 total, just west of Davis Ave S. Unit 1 said she was trying to
change lanes, moving to the right into lane #1. Unit one said she put on her blinker and started to
change lanes. As she changed lanes, she collided her passenger side of her vehicle with the front
end of unit#2. Unit 1 stated she did not see unit 2 in her mirrors prior to changing lanes. There was a
male passenger in the vehicle who refused to identify himself or received medical treatment despite
airbag deployment.
The following is a summary of what unit 2 told me happened. Unit 2 said she was also traveling east
bound on S 43rd ST, approaching Davis Ave S in the #1 of 3 lanes. Unit 2 said she was just driving
straight ahead when unit 1 who was slightly in front of her in lane #2 quickly merged over into her
lane causing her to hit unit 1 on the passenger side of unit 1 with the front end of her vehicle. The
passenger of unit 2 had no further important details to add to the story.
Both vehicles had moderate amounts of damage but were both still drivable and neither required a
tow. Both drivers were provided with an exchange of information before leaving. Unit 1 was not able
to provide her insurance information at the scene but was advised to email me that information when
she obtained it.
There were no other witness's, and I did not observe any video cameras in that area that would've
capture the accident.
This incident was captured by my body worn video camera. This report is a summary of the events
that occurred and is not an exact sequencing of events. Statements have been summarized and
paraphrased.
This concludes my involvement with this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by N. GIRELLO #12607 on 09/01/2023 at 2350 Renton, WA
PAGE 3 OF 4
REPORT NO. ED95741 CASE# 23-10126 DATE AND TIME 09/01/23 23:06
OF COLLISION
S 43RD<ST
m
PAGE 4 OF 4