HomeMy WebLinkAbout23-11968 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-11968 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
CowsloN 10 - 19 - 2023 1905 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 9TH ST BLOCK NO. e✓ 2500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e EDMONDS AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4258918144 0 11
30
6� LASTNAME I VAZQUEZ-RIOS FIRSTNAME MARIA MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 12707 SE 42ND ST CITY BELLEVUE ST WA 21p 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 2❑ P1ATE14 BNX5550 JBTATIJ WAuN# JN16J1CR9JW259917
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 1 5 33
vIN#'
12 0 0 VIN#
ROM TO
❑ VEH.YEAR 2018 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 NISS ROGUE UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO MARIOI REBOLLO 12707 SE 42ND ST BELLEVUE WA 98006 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� IN EF ITY INSURANCE� INSURANCE CO STATE FARM 087 7894-FO7047F 4
LI EFFECT &SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2066836223
16 2
LAST NAME CANTOR-PEREZ FIRST NAME CIPRIANO MIDDLE IG
INITIAL
17 STREET NEW ADOREs�' 188 HARDIE AVE SW CITY RENTON ST WA ZIP 98057 4❑ 37
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 DRIVER'S STATE WA SEX M D.C... 09 _ 08 _ 1990 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 4 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CDV7620 TArE WA VIN# 41
3FA6POHRXDR373129 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2013 MAKE FORD MODEL FUSIONS STYLE SO VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO GERSON DE LEON MORALES 1210 PIERCE PL NE RENTON WA 98056 VEHICLE NO.2
SHADE DA GEbAREA
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQ
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s � e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26LAN 12007 0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE12095
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11968
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) V►CENTE-SANTOS DARLIN S
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
RENTON WA SEX' F MMDDYYYY 02 - 24 - 1999
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. 6 4 4 1 USE 2 CLASS :1
NAME
(LAST,FIRST,MIDDLE INITIAL) VICENTE-SANTOS MELEYDI
ADDRESS&PHONE# D O B
RENTON WA SEX' F MMDovvvv O6 _ 14 _ 2015
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 4 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) TORRES-VICENTE YEIREN
ADOREss PHONE# RENTON WA M 11 30 _ 2015
SEX.
MMDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT g AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
❑ POS. USE GLASS
NARRATIVE'
On October 19, 2023 at 1905 hours dispatch requested that I respond to a collision at the intersection
of NE 9th St and Edmonds Ave NE, in the City of Renton, County of King, and State of Washington.
Upon my arrival I spoke with the driver of unit 1, a Nissan Rogue bearing Washington plates
BNX5550. The driver identified as Maria Vasquez-Rios, explained she was stopped at the
intersection facing southbound when the collision occurred. Maria stated she believed it was her turn
to proceed through the intersection, but collided with unit 2 as she proceeded crossed the roadway.
She believed unit 2 ran the stop sign, because she had previously allowed another vehicle to
proceed.
Unit 1 struck unit 2's passenger doors as she crossed the intersection.
I then spoke with unit 2, a Ford Fusion bearing Washington plates CDV7620. The driver, Cipriano G.
Cantor-Perez, stated he proceeded through the intersection after allowing other vehicles drive
through, but as he crossed the roadway, unit 1 drove into his passenger doors, sitting off the side
airbags.
I provided both drivers with an exchange of information. I was unable to determine who committed the
traffic violation, so no one was cited.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 10-20-23 01:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 1012312023 2:14:55 PM
BADGE OR ID# ! 12007 (DR]# WA0171300 TIME POLICE DISPATCHED 7:08 PM TIME POLICE ARRIVED',7:10 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE12095 CASE# ' 23-11968 DATE AND TIME 10/19/23 19:05
OF COLLISION
EDMONDS AVE NE
° NE 9TH ST
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