HomeMy WebLinkAbout23-13215 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-13215 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 2 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#
cawsloN 11 - 1-- 2023 1740 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ 2600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 26TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069098933 0 4 30
6❑ LAST NAME LASTIMOSA FIRSTNAME RICHARD MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 16814 160TH CT SE CITY RENTON ST WA ZIP 98058 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 06 1- 29 - 1973 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BWH6493 sTArI WAVIN# KNDEUCAA6M7127979
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 1 5 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR 2021 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 1 3 TOWED By GOVT.VEHICLE 34
13 4 KIA SElTOS SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 384 1001-D10.47F 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:3074215222
16 2
LAST NAME MARTINEZ FIRST NAME TRACY MIDDLE C
INITIAL
17 NEW STREETR 7' 10930 SE 172ND ST APT B201 CITY RENTON ST WA ZIP 98055 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK yEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA SEX F M .C.B. 04 30 _ 1971 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑LICENSE I 21❑ PLA E# CCF7152 TArE WA VIN# JF2(BTAEC8N8200441 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2022 MAKE $(JB�Q MODEL CI3OS$7- STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POLICY#E CO GEICO 6081935881IN 1 9TOP
VEHICLE YES[:] C—I CITATION# CHARGE io BOTTOM
LEGALLY N
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MICAH BATTLE 12049 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20505
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13215
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MARTINEZ ROBERT J
(LAST FIRST,
ADDRESS&PHONE# D O.B.
10930 SE 172ND ST APT B201 RENTON WA 98055 SEX M MMDDYyry 04 - 16 - 1960
SEAT HELMET INJURY NATURE OF INJURIEs
PASSENGERWITNESS[ UNIT# 2 POS 3 AIRBAG 2 RESTR. q EJECT 1 USE 2 CLASS 7 BACK PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
EX IMMDDYYYYI I-
T
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
23-13215
On 11/15/23 at 1804 hours, I was dispatched to an accident at 2600 Talbot Rd S within the City of
Renton, County of King, Washington.
Unit 1 (U1) was identified as Richard A. Lastimosa (6/29/73), who was driving WA-BWH6493.
Unit 2 (U2) was identified as Tracy C. Martinez (4/30/71), and front passenger Robert J. Martinez
(4/16/60), who were in WA-CCF7152.
U1 was traveling south on Talbot Rd S approaching the S 26th St intersection. He did not see U2
stopped in front of him and hit the rear end of U2 with his front end.
U2 was stopped facing south on Talbot Rd S indicating to turn left onto S 26th St. They were waiting
for oncoming traffic to pass before executing their turn, when U1 struck them from the rear.
U1 had airbag deployment but no complaints of paint. The passenger of U2 complained of back pain.
The Renton Fire Authority evaluated everyone on scene.
I observed substantial damage to U1's front end, and moderate damage to U2's rearend. No vehicles
were towed.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed, M. Battle 12049, 11/15/23, 2007
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAH BATTLE 11-16-23 05:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1 1111712023 1:52:17 AM
BADGE OR ID# 12049 OR]# WA0171300 TIME POLICE DISPATCHED! 5:42 PM TIME POLICE ARRIVED',6:21 PM
PART I PAGE IT]OF
REPORT NO. EE20505 CASE# ' 23-13215 DATE AND TIME 11/15/23 17:40
OF COLLISION
*Not drawn to scale
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