HomeMy WebLinkAbout23-13103 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13103 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#
cowsloN 11 - 1-- 2023 0741 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK M0 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV e ANACORTES AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2067955987 0 11
30
LAST NAME SANCHEZ HERNANDEZ FIRST NAME RODRIGO MIDDLE
6 INITIAL 1 2 31
STREET ❑ 2223 95TH PL SE CITY EVERETT ST WA 2jp, 982082963 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C22840J sTArI WAvIN# 1 FDUF5HT7GED49290
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13� 2016 FORD F550 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO SUPERIOR SYSTEMS AND LAND 222172ND STNE ARLINGTON WA98223 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO LIBERTYNWBAS53489071 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe 1 5 36
LEGALLY YES No CITATION# 3A0668513 CHARGE FAIL YIELD LEFT TURN MOTOR o Borrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064326703
16 a
LAST NAME PIMENTEL FIRST NAME MARIANN MIDDLE I C
INITIAL
17❑ STREET ❑', 554 GRANDEY WAY NE CITY' RENTON ST WA ZIP 980563625 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NoF,/
19[—] DRIVER #
{NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 USE 2 CLASS UPPER BODY PAIN
21❑ LICENSE BRT9425 TAre I WA VIN# WMWZG3C59CTY38474
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2012 MAKE MNNI MODEL COOPER STYLE I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO MARIANN PIMENTEL 3093126TH AVE S FEDERAL WAY WA 98003 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILYA104315806 IN EFFECTVEHICLE ❑ C[ CITATION# CHARGE C�Ql
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20425
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13103
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ZAVALA MARTIN E
(LAST FIRST,
ADDRESS&PHONE#
3811 NE 3RD CT#203 RENTON WA 980565826 4252479616 SEX M MMDDvyvv 03 - 27 - 2000
PASSENGER WITNESS UNIT# ' SEAT AIRBAG RESTR. EJECT ' HELMET INJURY
❑ NATURE of INJURIES
❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) RUTHERFORD SONJA M
ADDRESS&PHONE# D O B
2112 BLAINE AVE NE RENTON WA 980562786 3607908979 SEX F MMDDYVvv 07 _ 29 _ 1976
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was facing westbound in the left turn lane of westbound NE Sunset BLVD with a yellow
flashing arrow to turn left onto southbound Anacortes AVE NE. Unit 2 was traveling eastbound on NE
Sunset BLVD in the right of two eastbound lanes with the right of way. The left of the two eastbound
lanes was backed up with traffic from a traffic signal and Driver 1 stated he did not see Unit 2
approaching. Unit 1 failed to yield the right of way to Unit 2 and initiated the left-hand turn pulling into
the path of Unit 2. The front passenger wheel of Unit 1 was impacted by the front end of Unit 2. Unit
2 sustained moderate/heavy front end disabling damage and Driver 2 indicated upper body pain.
Unit 1 sustained minor damage to the front passenger wheel but the vehicle's oil filter was knocked
off rendering it disabled.
Driver 1 cited for failure to yield the right of way to a motor vehicle when making a left turn by failing to
yield to Unit 2, which was approaching with the right of way, which was the proximate cause of the
collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 11-14-23 08:52 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/16/2023 5:59:30 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 7:44 AM TIME POLICE ARRIVED',7:47 AM
PART I PAGE 2�OF❑
REPORT NO. EE20425 CASE# ' 23-13103 DATE AND TIME 11/14/23 07:41
OF COLLISION
i
in
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