HomeMy WebLinkAbout23-10349 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-10349 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 - 1-- 2023 1145 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a UNION AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO ,/ D:4255249726 0 4 30
6 LAST NAME MENDES OLIVEIRA FIRST NAME TROSANGELA MIDDLE M 1 2 31
INITIAL
STREET ❑ 4414 SE 4TH PL CITY RENTON ST WA 21p 980595127 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 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 1❑ P1 ATE 14 CGt6726 STATE WA VIN# JF2SHADC4CH438572
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 2 2012 SUBA FOREST DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ROSANGELA MEND ES OLIVEIRA 4414 SE 4TH PL RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 928281073 GIOBOTTOM
IN EFFECTPOLICY#VEHICLE CHARGE 36
LEGALLY YEs No clTAnoN# 3A0492523VEH ENTER INTERSEC STEADY RED
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062515062
16 a
LAST NAME LE FIRST NAME LIEN MIDDLE M
INITIAL
17❑ STREET ❑', 2020 ANACORTES AVE NE CITY RENTON ST WA ZIP 980593825 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NoF,/
19 LDI IVER # STATE WA SEX M M D.C.B. 11 11 1955 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I BBX1779 TATe WA vIN# WDDHF5G88BA514591
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2011 MAKE MERZ MODEL E3504D STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO LIEN LE 2020 ANACORTES AVE NE RENTON WA 98059 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE 8 POLICY#E CO PEMCO CA0513599IN IGQ
5
VEHICLE ❑ C—I CITATION# CHARGE
LEGALLY YES N`LJ
25 s 7 6
7KLANE
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97769
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10349
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'
Unit 1 was traveling westbound on NE 4th ST approaching Union AVE NE. Unit 2 was in the left turn
lane from eastbound NE 4th ST onto northbound Union AVE NE. Driver 2 states that he had a green
turn arrow and initiated his turn. Driver 1 states that she saw the turn arrows being green for the left
turn lane and didn't realize that the signal for westbound traffic was still red. Unit 1 proceeded into
the intersection against the red traffic signal as Unit 2 lawfully conducted its turn. The front end of
Unit 1 struck the passenger side of Unit 2 causing moderate damage to both vehicles.
Driver 1 was cited for entering the intersection against the red traffic signal which was the proximate
cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 09-07-23 01:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 911112023 9:49:49 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 11:48 AM TIME POLICE ARRIVED'11:54 AM
PART I PAGE IT]OF 3�
REPORT NO. ED97769 CASE# ' 23-10349 DATE AND TIME 09/07/23 11:45
OF COLLISION
'NOT TO SCALE*** w
z
UNION AVE NE
1
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