HomeMy WebLinkAbout23-12863 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-12863 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 CITY#
cowsloN 11 - 08 - 2023 0912 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
OAKESDALEAVESW ST e✓
MILEPOST 2700 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 27TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255283109 0 11
30
6 LAST NAME CASTANEDA ALONSO FIRST NAME MARISOL MIDDLE 1 2 31
INITIAL
STREET ❑ 446 MORRIS AVE S CITY RENTON ST WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
�/ I INTERLOCK YES[:]No NTERLOCKYEs NO YES R NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CBt6526 sTArI WAurN# 3MYDLBZV9GY109965
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2016 TOYT SCION SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO MARISOL CASTANEDAALONSO 446 MORRIS AVE S RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
EGHALLY YES❑NO❑ CITATION# 3A0379300 OP MOT VEH W/OUT INSURANCE o Borrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ 5093892189
VEHICLE CYCLE OWNER NO DD
16 a
LAST NAME MOHEIT FIRST NAME JAMES MIDDLE I B
INITIAL
17 STREET I❑ s❑' 3600E VALLEY RD FL UPSTAIRES CITY RENTON ST WA ZIP 980574909 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NO❑
19 LDI IVE STATE WA SEX M M D.C.B. 12 _ 26 _ 1985 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 9 EJECT 1 USE I CLASS 7 SORE NECK
LICENSE I ❑21❑ PLA E# CFY8744 TAre 41
WA vIN# 1NXBR12E41Z486282 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2009 MAKE TOYT MODEL COROLL STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMES MOHEIT 3600 E VALLEY RD FL UPSTAIRES RENTON WA 980574909 D:5093892189 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO ESURANCE PROPERTY AND CASUALTY INSURANCE PACA-008861865 I STOP 5
IN EFFECT
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N
s a
7JEE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# FENCY
26
VANDERHOEK 11631 A0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE19196
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12863
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'
Vehicle #1 was traveling northbound in the 2700 block of Oakesdale Ave SW, approaching SW 27th
St. Vehicle #2 was traveling westbound in the 1100 block of SW 27th St approaching Oakesdale Ave
SW. Vehicle #2 proceeded west through the intersection with a green traffic signal for westbound
traffic. As vehicle #2 was proceeding westbound through the intersection, vehicle #1 proceeed north
through the intrersection with a red traffic signal for northbound traffic. This caused the front end of
vehicle #1 to collide with the driver's side of vehicle #2. This incident was captured on a City of
Renton traffic camera and the video was uploaded to Evidence.com. The driver of vehicle #1 advised
via Language Line that she does not have insurance for her vehicle. Based on the totality of the
circumstances, it appears vehicle #1 caused this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 11-08-23 02:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 1111312023 1:51:46 PM
BADGE OR ID# 11631 ORI# ( WA0171300 TIME POLICE DISPATCHED; 9:13 AM TIME POLICE ARRIVED',9:13 AM
FART I PAGE IT]OF 3�
REPORT NO.! EE19196 CASE# ' 23-12863 DATE AND TIME 11/08/23 09:12
OF COLLISION
�Am�
Not to scale
SW 27th St
a
'Vehicle
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