HomeMy WebLinkAbout24-01618 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-01618 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 6 4 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# ❑
COLLISION'. 02 - 1-— 2024 2315 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 2700
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e NE 10TH ST
0 1 29
MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6 LAST NAME I RAMIREZ VASQUEZ FIRST NAME JOSE MIDDLE E 1 2 31
INITIAL
STREET 01 108 HOMER AVE SE CITY PACIFIC ST WA 2jp, 980471128 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 10 - 24 - 1996 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10� Pi aT�S� CDL7070 sTATe WAurN# 5XXGN4A75CG046431
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2012 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 KIA OPTIMA SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO DOSE RAMIREZ VASQUEZ 108 HOMER AVE SE PACIFIC WA 980471128 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO UNIVERSAL INS SERV 53-WA 6534803 3 4
IN EFFECT &POLICY# 9TOP
ve'CLe CHARGE 1 5 36
LEGALLv res❑NO❑ CITATION# 10 BOTTOM
15❑ STAMOTOIND'ING 8
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO �OLDMET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 LLIICENS # STATE SEX U MMDDYY 39
WELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''9 USE 9 CLASS 0 ❑
❑21❑ LICENSE UNKNOWN TATE VIN# 41
pLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE UNKN MODEL UNKNOW STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO UNKNOWN VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQ"'LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12651 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE50149
COLLISION REPORT III III III III III 111
1591972 CASE# 24-01618
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LUNA DE LA CERDA JESSICA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
108 HOMER AVE SE PACIFIC WA 980471128 4252958642 SEXi F MMDDvyry 01 - 09 - 1998
PASSENGER Z WITNESS❑ UNIT# 1 PEATOS 3 AIRBAG,2 RESTR. 4 EJECT ? 1 HELMET USE CLASS LASS 11 NATURE OF INJURIES
'
NAME
(LAST,FIRST,MIDDLE INITIAL) GEDAM ROBEL S
ADDRESS&PHONE# D O B
609 W NICKERSON ST APT 207 SEATTLE WA 98119 2068025643 SEX M MMDDvvvv 08 _ 13 _ 1986
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Hit and run with minimal suspect information. Both Units 1 and 2 were traveling north along 2700
block of NE Sunset Blvd. Unit 2 veers into Unit 1 causing non reportable non disabling rear driver side
quarter panel damage to Unit 1 and suspected non disabling non reportable front passenger side
damage to Unit 2. Unit 2 speeds off and does not remain on scene. No description of Unit 2 driver.
Only description of Unit 2 from the listed witness was that it was a white vehicle. Red paint transfer
upon Unit 1's vehicle at point of minor impact inconsistent with witness account. Unit 2 likely a red
vehicle. No injuries reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 02-14-24 12:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
BRYAN GROZAV 12489 2/14/2024 12:54:06 AM
BADGE OR ID# 12651 ORI#' WA0171300 TIME POLICE DISPATCHED; 11:20 PM TIME POLICE ARRIVED 11:22 PM
PART I PAGE IT]OF 3�
REPORT NO. EE50149 CASE# 24-01618 DATE AND TIME 02/13/24 23:15
OF COLLISION
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