HomeMy WebLinkAbout24-9424 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF12963 170
27
COLLISION REP FIT 1591971
CASE 24-9424 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 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 CITY# ❑
cowsloN 09 - 08 - 2024 0700 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4 STREET BLOCK NO. e✓ 3815
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066501313 0 11
30
6 LAST NAME POLICARPO SANTANA FIRST NAME ANTONIO MIDDLE 1 1 2 31
INITIAL
STREET ❑ 4455 NE 12TH ST,APT 19-9 CITY RENTON ST I WA 21p 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE CLJ2774 BTAT WA u N# JTNBB46K883048953
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 5 3 33
12 3 5 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR 2008 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GO VT.VEHICLE 7 $ 34
13 4 TOYT CAMRY P4 DAMAGE YES NO �MYERS YES❑ NO
REGISTERED OWNER INFO ALEJANDRA OCAMPO MARINES 4455 NE 12TH ST#19-9 RENTON WA 98059 D:2068591939 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO �3g
4
IN EFFECTI SUR N#VEHICLE CHARGE536
LEGALLv res NO CITATION#
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4257666201
16 a
LAST NAME ROGERS FIRST NAME JOHN MIDDLE M
INITIAL
17 STREET NEW ADOREs7 1248 CEDAR A VE#56 CITY l MARYSVILLE ST WA ZIP 98270 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF t—
YES t l NOF,—/]
19 LICENSE# STATE WA SEX M M .C.B. 05 _ 25 _ 1995 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLATE# XMT34352D TATE WA VIN1 3B6MC36592M263203 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2002 MAKE DODG MODEL FLEET STYLE TR VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO FLEET YES NO
REGISTERED OWNER INFO RENTON CITY OF3555 NE 2ND ST RENTON WA 98056 D:4257666201 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY INSURANCE INSU&PORGY#ECO CITY OF RENTON FLEET COVERAGE 1GD
IN EFFECT"'LE ❑ ,.I— CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF12963
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9424
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SOLANO SANT/AGO VALERIANO
(LAST FIRST,
ADDRESS&PHONE# D O.B.
216 DUVALL AVE SE RENTON WA 98059 2067123756 SEX M MMDDvyry 12 - 16 - 1997
PASSENGER I�I WITNESS� UNIT# 1 pO' 3 AIRBAG!2 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE of INJURIES
L�!1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) POLICARPO SANTANA LEONIDES
ADDRESS&PHONE# D O B
3815 NE 4 ST#E142 RENTON WA 98056 2065028238 SEX M MMDDvvvv 04 _ 24 _ 1996
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 9/08/24 around 0703 hours I was dispatched to 3815 NE 4th Street (City of Renton, County of
King, and State of Washington) due to a report of a vehicle collision. Upon arrival I contacted Driver
#1 who said he was coming out of the apartment exit in the 3815 block of NE 4th ST to make right
hand turn onto NE 4th ST to go Eastbound. Driver#1 said he looked right and then pulled out in
front of Vehicle #2. Driver#1 said he forgot to look left to make sure the lane was clear. Driver#1,
and passengers in Vehicle #1 said they were not injured. Vehicle #1 sustained heavy damage to the
front bumper, engine, wheels and quarter panels. Vehicle #1 was towed to Gene Myers towing.
Driver#2 said he was headed East bound on NE 4th ST when Vehicle #1 pulled out in front of him.
Driver#2 said that Vehicle #1 struck Vehicle #2 front quarter panel and caused damage all the way
down the passenger side of the vehicle. Vehicle #2 was towed by Bankers to the City of Renton
Shops. No injuries were reported by Driver#2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
DESIRES SCOTT 09-08-24 10:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 9/8/2024 10:23:00 AM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED; 7:04 AM TIME POLICE ARRIVED:7:07 AM
PART I PAGE IT]OF
REPORT NO.! EF12963 CASE# 24-9424 DATE AND TIME 09/08/24 07:00
OF COLLISION
j a A
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