HomeMy WebLinkAbout23-10532 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-10532 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
COLLISION.. 09 - 1-— 2023 1515 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MI!!AVE S
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2065514300 0 4 30
6 LAST NAME ALONSO ROMERO FIRST NAME MADISON MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 24242 26TH AVE S CITY DES MOINES ST WA Zjp, 98198 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO YEs No�/
8❑ LDRIVER # STATE WA SEX'F MMDDYY 01 - 29 - 2005 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10[1 P1 ATE 14
CEH9670 sTAr WAu N#' 3N1AB8CV9NY286824
0 TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 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 2022 NISS SENTRA 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO NORMA ROMERO SERRANO 2424226TH AVE S DES MOINES WA 98198 D:2065514300 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE INSURANCE CO ALLSTATE 807 597 657
FE 3 4
IN EFCT &POLICY# STOP
ve FE CHARGE 5 36
LEGALLY re6 No CITATION# 3A0334571 NO VALID OPER LICENSE WITH o eorrom
15❑ NDING 8 6
MOTOR PEDAL- '.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:2062298459
16 a
LAST NAME LAWSON FIRST NAME JESSICA MIDDLE M
INITIAL
17❑ STREET ❑', 2555 FLAT SHOALS RD APT 1405 CITY' COLLEGE PARK ST GA ZIP 303495175 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 DRIVERS
# STATE GA SEX IF Mr D.C.B. 04 29 _ 1983 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CEF2516 TAre WA VIN It 1HGCT1883FA009860
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2015 MAKE HOND MODEL ACCORD STYLE 2D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LINDA LAWSON 1615 HARRINGTON AVE SE RENTONWA98058 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO TRAVELERS 614014152 203 1IN 1ULlliKOTlTlfll;0-
7.111CjEo-SVEHICLE ❑ ,.I—I CITATION# CHARGELEGALLY YES N`LJ25 NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED98920
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10532
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
PM 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'
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.
CO.JOHNSON 09-14-23 05:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 911412023 5:56:31 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 3:37 PM TIME POLICE ARRIVED]3:44 PM
PART I PAGE IT]OF 4�
REPORT NO. ED98920 CASE# 23-10532 OF COLLISION
09/12/23 15:15
OF CbLLI510N
NARRATIVE
U2 turn left from S 3rd St to Mill Ave S from In #3; U1 turned left into U2 from In #2
On 09-12-2023 at about 1537 hours, I was dispatched to a collision in the area of the Renton Library
(100 Mill Ave S) in the City of Renton, County of King, Washington State. The involved vehicles were
no longer in the area and were currently located in a parking lot in the 2400 block of Maple Valley
Highway. The reported location of the vehicles was over one (1) mile away from the location of the
collision. I arrived in the area at about 1544 hours.
The driver of Unit 02 (WA - CEF2516) was identified by GA DL and was seated in the driver seat of
the vehicle. The driver did not complain of any injuries as a result of the collision. The driver was
unable to provide a specific address or street name where the collision occurred but mentioned a
meat pie restaurant in the area. I had the driver bring up a map on their telephone to assist with
identifying the location of the collision. The driver indicated they were in lane #3 (of 3) of east bound
S 3rd St at the intersection with Mill Ave S. The driver was turning left to go north bound onto Mill Ave
S and eventually Lake Washington. The driver said Unit 01 also turned left and hit her vehicle.
The driver of Unit 01 (WA - CEH9670) was identified with a punched WA ID. The driver was unable
to provide the vehicle registration nor proof of liability insurance. I asked the driver to describe what
happened during the collision. The driver was unable to articulate what happened or where the
collision occurred. I had the driver bring up a map on their telephone to assist with identifying the
location of the collision but she was unable to identify a specific location. The mother of the driver of
Unit 01 later arrived on scene and displayed the vehicle registration and vehicle insurance on her
telephone.
East bound S 3rd St and the intersection with Mill Ave S is a one-way street with three (3) lanes of
travel. Lanes #1 and #2 are for traffic continuing straight onto Houser Way S. Lane #3 is for traffic
turning left onto Mill Ave S.
I observed moderate damage to the rear driver side door of Unit 01 and moderate damage to the
passenger side fender of Unit 02.
Checks via DOL of the driver of Unit 01 returned Not Licensed - Eligible. The driver of Unit 01
operated a motor vehicle upon a highway in this state without a valid driver's license.
Checks via DOL of Unit 01 returned expired 08-20-2023. The vehicle displayed 08-2023.
Notice of Infraction for NVOL2 and expired vehicle license sent to Renton Municipal Court to mail to
the driver of Unit 01.
There were no independent witnesses to the collision.
PAGE 3 OF 4
REPORT NO. ED98920 CASE# ' 23-10532 DATE AND TIME 09/12/23 15:15
OF COLLISION
CEN E NOT OBE"'ERVED
PAGE 4 OF 4