HomeMy WebLinkAbout23-11297 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE06442 170
27
COLLISION REP FIT 1591971
CASE 23-11297 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 10 - 1-— 2023 2342 17 ❑.❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD ST BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:9095018404 30
6 LAST NAME ARRIAGA RAMIREZ FIRST NAME ELVIS MIDDLE 1 1 2 31
INITIAL
STREET ❑, 11710 SE 157TH ST CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YEs No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit CJN1675 sTArI WA vrN#' 3N1AB8DV3PY259362
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 3 33
12❑ VIN#j VIN#
FROM
34
13� VEH.YEAR 2O23 MAKE NISS MODEL SENTRA STYLE SD VEHICLE TOWED NOO pLSABLIN TQ yED.BLRS YES[:]DAMAGE IILLJJII ttSSAA1IVV/i��66
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI VINSURANCE INSURANCE CO STATE FARM 5393157 E0947B 3 4
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STAIN.D'ING 8 7 6
UNIT VE IOOR El CYCLE PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1GQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MIN FLICK 12825 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE06442
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11297
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'
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.
BENJAMIN FLICK 10-03-23 01:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 101612023 12:36:00 PM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 11:42 PM TIME POLICE ARRIVED',11:42 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE06442 CASE# 23-11297 OF COLLISION
10/02/23 23:42
OF CbLLI510N
NARRATIVE
23-11297
On 10-02-2023 at approximately 2342 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision in the
400 block of S 43rd ST. This collision had been on-viewed by Renton PD.
Upon arrival I made contact with the driver and vehicle involved. The involved vehicle and driver were
identified as follows:
Unit 1 (WA/CJN1675) driver Elvis Arriaga Ramirez (DOB: 05-05-2002 via WADL).
Unit 01 had just exited the freeway (SR167) northbound onto S 43rd ST and made a right turn to go
east on S 43rd ST. During the turn he struck the curb on the south side of S 43rd ST. The only
damage was to his own vehicle, possible a broken tie rod. He called for a tow and Bankers towed the
vehicle.
There were no injuries.
I provided him with the case number. He provided insurance. I did not write any citations as the only
damage was to his own vehicle.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 10-03-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE00442 CASE# 23-11207 DATE AND TIME 10/02/2323:42
OF COLLISION
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