HomeMy WebLinkAbout23-12300 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12300 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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 10 - 1-- 2023 2033 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE CARR ROAD BLOCK NO. e✓ 10200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a 103RD AVENUE SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4254959159 0 7 30
6� LAST NAME VARGAS FIRSTNAME FRANKLIN MIDDLE I M 1 1 2 31
INITIAL
STREET ❑, 10833 SE 172ND STREET 7D CITy RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 EJECT 1 H U EETI I INJURY [NATURE
CLASS 6 IMPACT F INJURIES 2❑
3
10 9❑ P1 ATNES# CHN6900 sTAr WAu N# 5NPD84LF2HH061754
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34
13 4 HYUN ELANTR 4D DAMAGE YES NO �AWAS TOWING YES❑ NO
REGISTERED OWNER INFO ALEXANDRAVARGAS 1.33 SE 172ND STD7 RENTONWA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO ALL STATE 991027 383 4
IN EFFECT &POLICY#VEHICLE CHARGE 36
15❑ LEGALLYYES❑NO❑ CITATION# 3A0614163 INATTENTION <1�3
orrow
STANDING 7 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE OWNER
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ 711
YES�/ NO DD 2532261289
16 a
LAST NAME DREW FIRST NAME DONNA MIDDLE R
INITIAL
17❑ STREET ❑', 27221 124TH AVE CT E CITY' GRAHAM ST WA ZIP 98338 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 D IVERI # STATE WA SEX F M D.C.B. 11 21 1968 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES ❑ 40
USE I CLASS IMPACT
21❑ LICENSE I CEU1669 TArE WA VIN1I WBA13AR07MCF87547
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE BMW MODEL M440XI STYLE P2 VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DONNA DREW 27221124TH AVE CT E GRAHAM WA 98338 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2011671785 1 9TOP
IN EFFECT
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES NC[:]
25❑ J s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.SAG/AO 10339 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE14815
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12300
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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.
E.SAGIAO 10-26-23 10:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 1013112023 7:14:16 AM
BADGE OR ID# 10339 OR]# WA0171300 TIME POLICE DISPATCHED; 8:35 PM TIME POLICE ARRIVED',8:37 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE14815 CASE# 23-12300 OF COLLISION
10/26/23 20:33
OF CbLLI510N
NARRATIVE
On 10-26-23 at 2035 hours I was dispatched to a collision in the 10200 block of SE Carr Road, in the
City of Renton, King County, State of Washington.
Unit#1 was a silver 2017 Hyundai Elantra (WA-CHN6900). Unit#2 was dark blue 2021 BMW
M440XI (WA-CEU1669).
Unit#2 driver was also the registered owner, Donna Drew who I identified by WA DL. She relayed
she was heading eastbound, uphill on Carr Road ad the vehicle stopped in front of her to take left turn
onto 103rd Avenue SE. Unit#1 came from behind and collided with her vehicle while she was
stopped behind the vehicle waiting to make a left turn.
Unit#1 driver was identified by WA DL as Franklin M. Vargas. He advised he tried to stop but was
unable to.
Unit#1 made contact with the rear of Unit#2 and was wedged so far into it that a tow truck had to
pull them apart. Minor injuries were reported on scene and RFA arrived to evaluate them.
Damage was consistent with accounts provided. Unit#1 driver was advised he would be cited
through Renton court for inattention. Unit#1 driver was the at fault driver. Unit#1 was towed by
Banker's Towing to their tow yard. Unit#2 used a private tow. Both drivers were provided an
exchange of information.
The incident was captured on my body worn camera. The report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
I certify or declare under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
E.Sagiao/10339
PAGE 3 OF 4
REPORT NO.! EE14815 CASE# 23-12300 DATE AND TIME 10/26/23 20:33
OF COLLISION
SE Carr Road
103rd Avenue SE Private Drive
SE Carr Read
PAGE 4 OF 4