HomeMy WebLinkAbout23-12860 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12860 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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 11 - 1-- 2023 0838 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HOQUTAMAVENE BLOCK MILEPOST ST e✓ 1100
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259194489 0 11
30
6 LAST NAME MORALES CARRERA FIRSTNAME LUIS MIDDLE E 1 2 31
INITIAL
STREET ❑ 14235 169TH AVE SE CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 02 1- 03 - 2005 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 2❑
USE CLASS AIRBAG DEPLOYMENT INJURY/ABDOMINAL PAIN
10 9❑ PI ATNE 14 BV61887 sTArE WAV N#' 19XF62F53DE24f776
3
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM TO
TRLR 5 7. TRLR 33
12 2 5 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 F 2013 HOND CIVIC DAMAGE YES NO � '` RS YES❑ NO✓
REGISTERED OWNER INFO SILVIA CARRERA GOMEZ 11235169THAVE SE RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO
14 LIABILITY INSURANCE� PACIFIC STAR 5551898
IN EFFECT &POLICY# 9TOP
vE FFE CHARGE 1 10BOTTOM 5 36
LEGALLY YES No CITAnoN# 3A0668511,3A0668511 FAIL YIELD LEFT TURN MOTOR
15❑ STANDING 8 6
MOTOR PEDAL- PR OWNER OPERTY DAM THR OLD MET PHONE
16
U VEHICLE CYCLE-02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2069662255
a '.
LAST NAME MCCARTHY FIRST NAME MARCUS MIDDLE I J
INITIAL
17❑ STREET ❑', 1117 N 33RD PL CITY' RENTON ST WA ZIP 980561931 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVEW # STATE WA SEX M M MD D.
01 16 _ 2006 El 39
CENS —NATURE OF
W USE
EET LASS 7
Y GENERALINJURIES PAIN/AIRBAG DEPLOYMENT 40
20 ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 2
21❑ LICENSE I CF(a0875 TAre WA YIN# JTKDE167280272390
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE TOYT MODEL SCION TC STYLE I VEHICLE TOWED TO BLIN TOWED BY GOV HI �44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO TIMOTHY MC CARTHY 1117 N 33RD PL RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU PORGY#E CO ALLSTATE 964620120IN 9TOP 5
vewcLe ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77T�NCY
26
K.LANE 10008 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20383
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12860
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 traveling northbound on Hoquiam AVE NE in front of Hazen High Scholl (1101 Hoquiam
AVE NE) intending to turn left into the north parking lot of Hazen. Unit 2 was traveling southbound on
Hoquiam AVE NE approaching the north parking lot of Hazen High School with the right of way. Unit
1 failed to yield the right of way to Unit 2 and initiated this left turn in front of Unit 2. The front end of
Unit 2 impacted the passenger side of Unit 1 causing moderate/heavy disabling damage to both
vehicles and airbag deployment. Driver 1 (ID'd via Hazen student ID and mother's identification) did
not have a drivers license and DOL status was ID only. Driver 1 complained of abdominal pain and
was transported to Valley Medical Center.
Driver 1 cited for failure to yield the right of way when making a left turn by failing to yield the right of
way to Unit 2 and turning left in front of them which was the proximate cause of the collision. Driver 1
also cited for No Valid Operators License 2nd by operating a motor vehicle without a valid operators
license.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 11-08-23 01:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/16/2023 4:16:46 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED', 8:39 AM TIME POLICE ARRIVED',8:40 AM
PART I PAGE IT]OF
REPORT NO. EE20383 CASE# ' 23-12860 DATE AND TIME 11/08/23 08:38
OF COLLISION
0T TO SC
ENE
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