HomeMy WebLinkAbout23-12973 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-12973 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cowsloN 11 - 10 - 2023 1840 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW SUNSET BLVD BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OF HARDIEAVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4252696517 0 4 30
6� LAST NAME CORRAL FIRSTNAME RICARDO MIDDLE S 1 1 2 31
INITIAL
STREET ❑, 18012 SE 146TH ST CITY RENTON ST WA Zlp' 98059 z=
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C89064R sTArI WAurN# 1 FTFX1 E42KKC51813
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 5 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 A 2019 FORD F150 TR DAMAGE YES NO ves❑ No
REGISTERED OWNER WFO RICARDO CORRAL 18012 SE 146TH ST RENTON WA 98059 D:4252696517 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE70885612 3 4
IN EFFECT &POLICY# 9TOP
LEwcL I CHARGE 1 5 36
LEH'C YES❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4259028548
16 a
LAST NAME RICHARDSON FIRST NAME GRACE AMAYA MIDDLE L
INITIAL
17 STREET I❑ s❑' 4803 SADDLEBACK DR NW CITY' GIG HARBOR ST WA ZIP 98332 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO�
19 LDIRRS IVE STATE WA ]SEX IF M .C... 01 16 _ 2007 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET NJAU EY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BDY0419 TArE 41
WA YIN# 1C4SDJCT1HC726131 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE DODE MODEL DURANG STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO GRACE AMAYA RICHARDSON 4803 SADDLEBACK DR NW GIG HARBOR WA 98332 D:4259028548 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO TRAVELERS 607338582203IN STOP 5
vewcLE 25 YES❑ N u CITATION# CHARGE to BOTTOM
LEGALLY s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J RA YGOZA 12503 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20113
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12973
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
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.
J RAYGOZA 11-10-23 10:52 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1111612023 1:27:49 AM
BADGE OR ID# 12503 OR]# WA0171300 TIME POLICE DISPATCHED 7:13 PM TIME POLICE ARRIVED',7:20 PM
PART I PAGE IT]OF 4�
REPORT NO. EE20113 CASE# 23-12973 OF COLLISION
11/10/23 18:40
OF CbLLI510N
NARRATIVE
RPD CASE#: 23-12973
On 11/10/2023 at approximately 1913 hours, I responded to the intersection of SW Sunset Blvd and
Hardie Ave SW, in the City of Renton, King County, Washington, for a report of a non-injury two
vehicle collision.
Upon arrival both vehicles had pulled into the parking lot of Key Bank, located at 53 SW Sunset Blvd.
I identified Unit 1 as a black 2019 Ford F150 bearing WA license #C89064R
VIN#1 FTFX1 E42KKC51813. Unit 1 sustained damage to the driver's side door and the rear driver's
side passenger door of the vehicle. I identified the driver of Unit 1 via his WADL as Corral Ricardo
Santiago (DOB 12/24/1981). Ricardo told me he was driving north from Fred Meyer towards the
intersection of SW Sunset Blvd and Hardie Ave SW. Ricardo said he had a green light and drove
straight when Unit 2 failed to yield as they were making a left turn to get onto SW Sunset Blvd from
Hardie Ave SW and collided with his vehicle. Ricardo told me he was not injured and provided me
with his driver's license, registration and insurance.
I identified Unit 2 as a black 2017 Dodge Durango, bearing WA license #BDY0419
VIN#1 C4SDJCTI HC726131. Unit 2 sustained minor damage to the front driver's side of the vehicle.
identified the driver of Unit 2 via her WADL as Richardson, Grace Amaya Lynn (DOB 01/16/2007).
Richardson told me she was driving southbound on Hardie Ave SW towards the intersection of SW
Sunset Blvd and Hardie Ave SW. Richardson stated she had a green light and that she was making a
left turn at the intersection to get onto SW Sunset Blvd but was struck by Unit 1. Richardson stated
she was not injured and provided me with her driver's license and registration.
I was unable to decide who was at fault and informed both parties to exchange information so that
their insurances could speak to one another. I also provided both parties with my business card and
case number.
Once both parties left the area, I cleared the scene.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Raygoza on 11/10/2023 at 2100 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EE20113 CASE# ' 23-12973 DATE AND TIME 11/10/23 18:40
OF COLLISION
Unit 2
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