HomeMy WebLinkAbout24-107 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-1o7 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE dF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 01 - 1-- 2024 0808 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
SUNSET BLVD NE ST e✓
MILEPOST 200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W 8 NE 3RD ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2063493510 0 6 30
6� LAST NAME MAR FIRSTNAME BRIAN MIDDLE T 1 1 2 31
INITIAL
STREET ❑✓ 575 OLYMPIA AVE NE CITY RENTON ST WA ZIP 98056 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10� P1 aT�S� 223YMG sTATe WAurN# 2HGFA16579H314593
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# ROM TO
TRLR. TRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2009 HOND CIVIC SD MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO BRIAN MAR 218118THPL SW BOTHELL WA 98012 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� IN EFFECT ITY INSURANCE Z INSURANCE E CO AMERICAN FAMILY INSURANCE41006-48562.68 <1�3 4
LI EFFECTISUR N# TOPVEr1ICLE CHARGE 36
LEGALLY YES❑NO CITATION# 4AO091134INATTENTIVE DRIVING orrom
15❑ STANDING 6
MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4257734652
VEHICLE CYCLE OWNER YES NO ,/
16 a
LAST NAME MANCIA RAMIREZ FIRST NAME ERLINDA MIDDLE N
INITIAL
17❑ STREET NEW ADDREss❑' 220 SHATTUCK AVE S CITY RENTON ST WA ZIP 980572021 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs❑NOF YES❑NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CBT6376 TATE WA VIN# 41
JN8AT2MT9HW136393 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2017 MAKE NISS MODEL ROGUE STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ERLINDA MANCIA RAMIREZ 220 SHATTUCK AVE S RENTON WA 980572021 D:4257734652 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 5379201-ED01-47IN 1 STOP
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE39315
COLLISION REPORT III III III III III 111
1591972 CASE# 24-107
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) C/TAN MANCIA YARELI N
(LAST FIRST,
ADDRESS&PHONE# D O.B.
220 SHATTUCK AVE S RENTON WA 98057 SEXi F MMDDYyry 12 - 16 - 2017
PASSENGER WITNESS UNIT# SST AIRBAG' RESTR. EJECT ' HELMET LASS NATURE OF INJURIES
❑✓ ❑; 2 SOS. 9 1 10 1 USE 2 CLASS 1
NAME
'(LAST,FIRS MIDDLE INITIAL)
ADDRESS&PHONE# D O B
Ex MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
I was dispatched to a collision on 01/04/24 at 0808 hours at N 3rd St and Sunset Blvd N in the 200
block, in city Renton, King County WA.
Unit 1 223YMG Driver Brian T. Mar (DOB 02/15/1982)
Unit 2 CBT6376 Driver: Erlinda N. Mancis-Ramirez (12/04/1997)
All drivers were identified by their WADL. All drivers had the same account of what occurred.
Unit 2 was going North on Sunset Blvd N. Unit 2 turned into lane 1 to turn East on NE 3rd St and
begun to slowdown. Unit 1 was traveling North behind Unit 2 on Sunset Blvd N in lane 1 when he
wanted to merge into lane 2. Unit 1 then looked to clear lane 2, and when he looked back into his
lane, he saw Unit 2 in front of him, and could not stop before colliding into Unit 2.
Both drivers stated they had no injuries and did not need medical attention.
The driver of Unit 1 Brian T. Mar (DOB 02/15/1982) was cited with Inattentive driving.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 01-04-24 05:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 111112024 6:20:15 AM
BADGE OR ID# 12808 OR]#' WA0171300 TIME POLICE DISPATCHED 8:92 AM TIME POLICE ARRIVED]8:15 AM
PART I PAGE IT]OF❑
REPORT NO. EE39315 CASE# ' 24-107 DATE AND TIME 01/04/24 08:08
OF COLLISION
4,
P
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