HomeMy WebLinkAbout23-12007 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE13477 170
27
COLLISION REP FIT 1591971
CASE 23-12007 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
cawsloN 10 - 1-- 2023 1836 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLV N BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1,❑ FEET e S ❑ VV a I405 N
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064837768 0 11
30
6� LAST NAME TRUJILLO FIRSTNAME AMADEO MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 15 MURRAY PL CITY ELMA
NEW ADDRESS ST ZIP 96541 2
',
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
❑ DRIVER'S' STATE Mx SEX'M MELO B 04 1- 07 - 1997 2 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 CFZ8226 STATE WAa VIN# 1 C3CDFAH6DD313811
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM TO
TRLR. A'RLR. 1 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 1 34
13 6 2013 DODG DART SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
❑ ❑ 2 3 4
14 LIABILITY INSURANCE INSURANCE CO NIA
IN EFFECT &POLICY# � 9TOP 5
VEH" CHARGE 10 BOTTOM 36
LEGALLY YES❑NO❑ CITATION# 3AO703670,3AO703670, OP MOT VEH W/OUT INSURANCE,NO 5
15❑ STANDING
MOTOR PEDAL-:. '.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254448648
16 a
LAST NAME CETINO FIRST NAME EDGAR MIDDLE R
INITIAL
17❑ STREET NEW ADDREsB❑' 915 REDMOND AVE NE CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVER # STATE WA SEX M M D.C.B. 09 _ 01 1966 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# C47475L TATE WA VIN 41
3TMCZ5AN6HM115902 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2017 MAKE 7'Oy7' MODEL TACOMA STYLE PK DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
VE."LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JASON TURNER 12650 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE13477
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12007
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 1 was travelong northbound on the 1405 northbound ramp but realized they needed to merge left
to continue north bound on Sunset Blvd NE. Unit 2 was traveling northbound on Sunset Blvd NE
passing the 1405 ramp. Unit 1 attempted to merge left directly in the path of travel of unit 2. This
caused unit 1 to collide with unit 2's vehicle leading.
Both driver's reported no injuries. Unit 1 had minor damage to the front bumper of and passenger side
of their vehicle. Unit 2 had major damage to the front of their vehicle. Unit 1 did not have a valid
license and did not have insurance. Unit 1 was cited for Driving without a license with valid ID, Failure
to provide insurance, and
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 10-21-23 11:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 1012712023 2:02:34 AM
BADGE OR ID# 12650 OR]#' WA0171300 TIME POLICE DISPATCHED 6:36 PM TIME POLICE ARRIVED 6:44 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE13477 CASE# ' 23-12007 DATE AND TIME 10/20/23 18:36
OF COLLISION
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