HomeMy WebLinkAbout23-10500 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-10500 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 09 - 11 - 2023 1440 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FEET MILES e S B W e N 8TH ST
2 0 29
MOTU '�01 VEHtOR PI CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE Q 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY DES MOINES ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 AJJ7640 STATE WA VIN#' 183HB28B47D593381
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 4 2007 DODG CHARG 4H DAMAGE YES NO YES
❑ NO✓
REGISTERED OWNER INFO SERGIO LOPEZ .RA 1121 SHERMAN ST PORT TOWNSEND WA 98368 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2067926588
16 a
LAST NAME SINEA FIRST NAME RAZVAN MIDDLE /
INITIAL
17 STREET❑ NEW ADOREss❑' 21822 13TH AVE S CITY DES MOINES ST WA ZIP 981988330 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 10 _ 27 1993 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CDM2903 TATE 41
WA VIN# 1NXBR32ESSZ511515 4
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2005 MAKE TOYT MODEL COROLL STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO IOAN SINEA 2182213TH AVE S DES MOINES WA 98198 VEHICLE NO.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04194484459IN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JAC08S 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE02936
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10500
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 9-11-23 at about 1503 1 contacted unit 2 in a parking lot reference the following collision. Driver 1
was identified via his WADS as Razvan Sinea. Sinea told me;
He was in lane 2, southbound when unit 1 (WA Plate AJJ-7640) merged into his lane and collided
with the passenger's side of his vehicle.
Unit 1 then took off without exchanging information.
He attempted to follow until unit 1's driving was uncomfortable.
He then pulled over and waited to police to arrive.
He thinks he would be able to recognize the driver of unit 1.
He was not injured in the collision.
The damage to unit 2 did not appear extensive. Follow up with the registered owner of unit is
required.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 09-21-23 09:05 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 912712023 10:17:59 AM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED; 2:50 PM TIME POLICE ARRIVED',3:03 PM
PART I PAGE IT]OF 3�
REPORT NO. EE02936 CASE# ' 23-10500 DATE AND TIME 09/11/23 14:40
OF COLLISION
W
Non
f
Jot drawn t0 scale r
r-r
Logan AfV
r
r n
0
Unit
PAGE 3 OF 3