HomeMy WebLinkAbout24-1750 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-1750 2
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#
cowsloN 02 - 1-- 2024 1816 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAWER AVE N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e AIRPORT WAY
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4256239644 0 4 30
6 LAST NAME CARMONA GARCIA FIRSTNAME MARTHA MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 1720 HARRINGTON AVE NE CITY RENTON ST WA 2jp, 980562327 z
NEW ADDRESS
7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CGJ1825 sTArI WAurN# 1FAFP37N46W181088
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 4 FORD FOCUS P4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LIZZETTPAREDES CARMONA 210 MARTIN LUTHER KING JR WAY SEATTLE WA 98122 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T 02 VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YEs NO ,/ D:4259414966
16 a
LAST NAME WALEN FIRST NAME NICHOLAS MIDDLE A
INITIAL
17 STREET❑ NEW ADOREss❑' 8609 309TH PL SE CITY' PRESTON ST WA ZIP 980500000 4❑ 37
18❑ CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES
t l NOF,/
19[ DRIVER# STATE WA SEX M M DDY
D.C.B.
07 24 1983 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CBN3402 TArE 41
WA VIN# 1GYS4CKJXGR400068 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE CADI MODEL ESCALAD STYLE 4B VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO,/ YES NO
REGISTERED OWNER INFO NICHOLAS WALEN 32524 SE 108TH ST ISSAQUAH WA 98027 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 967 368 617IN 1 9TOP 5
VEHICLE ❑ C[ CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 s e
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. EE52478
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1750
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FOWLER MICHELLES
(LAST FIRST,
ADDRESS&PHONE# D O.B.
32524 SE 108TH ST ISSAQUAH WA 980278769 SEXi F MMDDYyry 05 - 30 - 1971
PASSENGER WITNESS[:] UNIT# ' 2 POS USE 2 CLASS 3 AIRBAG j 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
i1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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'
I was dispatched to the collision on 02/17/24 at 1820 hours at the intersection of Airport Way and
Rainer Ave N in city Renton, King County WA.
Unit 1 CGJ1825 Driver Martha E. Carmona Garcia (DOB 10/09/1975)
Unit 2 CBN3402 Driver Nicholas A. Walen (07/24/1983)
Drivers of vehicles 2 was identified by his WADL and driver of vehicle 1 was identified by their WAID.
Unit 2 stated he was traveling South on Rainer Ave N when he was in the outer left turning lane to
turn onto Airport Way. He said when the light turned green, and he begun to driver forward Unit 1
turned into the side of his vehicle hitting the passenger side of Unit 2. Unit 1 said they were traveling
South on Rainer Ave N when Unit 2 hit them. The damage to the vehicles is consistent with Unit 2's
recall of the accident.
Upon request Martha E. Carmona Garcia (DOB 10/09/1975) was unable to provide proof of insurance
and a valid driver license.
Martha was cited for operating a motor vehicle without insurance, no valid operating license while
operating a motor vehicle.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 02-17-24 10:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
BRYAN GROZAV 12489 1 2/21/2024 11:02:19 PM
BADGE OR ID# 12808 ORI#' WA0171300 TIME POLICE DISPATCHED 6:20 PM TIME POLICE ARRIVED',6:24 PM
PART I PAGE IT]OF 3�
REPORT NO. EE52478 CASE# ' 24-1750 DATE AND TIME 02/17/24 18:16
OF COLLISION
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