HomeMy WebLinkAbout23-10502 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-10502 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I 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 - 11 - 2023 1447 17 �. S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ p ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LOGAN AVE N
2 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2068549473 2 3 30
LAST NAME VALERIANO-REYES FIRST NAME ZITLALY MIDDLE A
6 INITIAL 1 2 31
STREET ❑✓ 3518 NE 9TH ST CITY RENTON ST WA ZIP 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 04 1- 20 - 2007 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� /afN8257 sTArI WAurN# 1GNEC13R1YR130851
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 2 2000 CHEV TAHOE DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO GERARDO VALERIANO 861 DAYTONAVE NE RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 IN EF IT INSURANCE PROGRESSIVE 909005869
IN EFFECT &POLICY# 9TOP
ve'CLE CHARGE 10BOTTOM 5 36
LEGALLY YES No clTAnoN# 3AO492526,3AO492526 NEGLIGENT DRIVING 2ND DEGREE,
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE � CYCLE ❑ PEDESTRIAN � OWNER ❑ YES No ,/ D:3523155240
16 a
LAST NAME PRAK FIRST NAME MALYDEN MIDDLE
INITIAL
17❑ STREET ❑', 30011THAVEN CITY'ALGONA ST; WA ZIP 980016514 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVERI # STATE WA ]SEX IF M .C.B. 05 _ 08 _ 1984 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AFM5090 TAre WA VIN# 5TDBK3EH18S091265
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO MALYDEN PRAK 30011TH AVE N ALGONA WA 98001 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO STATE FARM 150 9140-CO7-47CIN 1GQVEHICLE
❑ C—I CITATION# CHARGE
LEGALLY YES N`LJ
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01699
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10502
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 2 was stopped for a red light on eastbound Airport Way waiting to follow the curve left onto
northbound Logan AVE N. Unit 1 was directly behind Unit 2 also eastbound on Airport Way waiting to
follow the curve left onto northbound Logan AVE N. When the light turned green, Unit 2 began to
accelerate but then had to slow for traffic in the intersection that was congested. Driver 1 stated they
saw traffic begin to move so she accelerated but either did not see or was unable to negotiate the
traffic stopping in front of her. The front end of Unit 1 struck the rear end of Unit 2 causing moderate
damage to both vehicles.
Driver 1 is a 16 year old, unlicensed driver (confirmed via DOL check as NOT LICENSED-ELIGIBLE).
She stated she took the vehicle from her residence without her parents knowledge or permission
which was confirmed by father who arrived on scene. Based on the fact Driver 1 was operating a
motor vehicle without training or knowledge to a level required by licensing or permit, this was
deemed negligent. Based on this determination, Driver 1 was cited with Negligent Driving 2nd
degree by operating a motor vehicle in this negligent manner which resulted in a collision thus
endangering persons and property.
Driver 1 also cited for No Valid Operators License (NVOL) 2nd degree. This is based on the fact she
operated a motor vehicle without a drivers license or permit but with valid ID.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 09-12-23 01:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 9/23/2023 8:50:29 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED; 2:52 Pry TIME POLICE ARRIVED]3:08 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE01699 CASE# ' 23-10502 DATE AND TIME 09/11/23 14:47
OF COLLISION
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