HomeMy WebLinkAbout24-1200 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-1200 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# z❑
COLLISION'. 02 - 01 - 2024 1953 17 ❑.❑ S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e ---
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FEET MILES e S ❑ W e N 10TH PL
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2062288563 0 7 30
6� LAST NAME RUIZ-SABALSA FIRSTNAME JOSE MIDDLE E 1 2 31
INITIAL
STREET ❑✓ 221 WELLS AVE N CITY RENTON ST WA 21p 98057 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' ID
M MELO B 06 1- 03 - 1997 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� D94476D sTArI WAVIN# 1FT8W36T3KEF67433
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2019 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 9 9 34
13 FORD F350 PK DAMAGE YES NO �MEYERS YES❑ NO✓
REGISTERED OWNER INFO JOSE RUIZ-SABALSA 221 WELLS AVE N RENTON WA 98057 D:2062288563 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4
14 LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
LEGALLv Yes❑NO❑ CITATION# CHARGE
1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2066436344
16 a
LAST NAME NO L FIRST NAME JEREMIAH MIDDLE R
INITIAL
17 NEW STREETREs7 9815 S 247TH CT CITY KENT ST WA ZIP 98030 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 M M D.C.B. O6 _ 28 _ 2002 39
20 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES 40
USE CLASS BACK AND NECK PAIN
LICENSE I ❑21❑ PLA E# CFH4286 TArE 41
WA VIN# 5YJ3E1EA9PF383437 1
42
22❑ PLATE# STATE TILER PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2023 MAKE TESL MODEL MODE!3 STYLE $D —YEHICLE
TOWED✓ NOO BLIN GENE MEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU8 PORGY#E CO AMERICAN FAMILYA103844399 IU
STOP
IN EFFECT
VE."Le CITATION# CHARGE o BOTTOMES N�25 J
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE47403
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1200
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
POS. 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'
Unit 2 was proceeding southwest on Logan Ave N in the in the number 1 lane. Unit 1 was also
proceeding southwest on Logan Ave N in the number 1 lane. Unit 2 stopped in approximately the
1000 block to make a left turn into The Landing parking garage, Unit 2 was legally standing waiting
for traffic to cease before completing a left turn. Unit 1 did not stop and continued driving in the
number 1, Unit 1 then collided with the rear end of Unit 2's vehicle.
Unit 1 had extensive front end damage, with oil leaking from the vehicle, Unit 1 was later towed by
Gene Meyers. Unit 2 had extensive damage to the rear end of the vehicle and was also towed by
Gene Meyers.
The driver of Unit 1 stated that he had no injuries, Unit 1's vehicle also had a passenger who refused
to identify himself. The driver of Unit 2 reported that he had minor back and neck pain.
Driver 1 was cited for Following Too Closely as he failed to leave enough following distance to react
appropriately to Unit 2 stopping. Driver 1 was also cited for Operating Without Insurance as he could
not provide proof of valid insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 02-01-24 10:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 21512024 6:53:04 AM
BADGE OR ID# 12650 ORI#' i WA0171300 TIME POLICE DISPATCHED 8:00 Pry TIME POLICE ARRIVED',8:08 Pry
PART I PAGE IT]OF
REPORT NO. EE47403 CASE# ' 24-1200 DATE AND TIME 02/01/24 19:53
OF COLLISION
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