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Home My WebLink About23-10790 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-10790 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 8 28 TOTAL#OF OBJECT TRIBAL QUILEUTE TRIBE UNITS 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# cowsloN 09 - 19 - 2023 1425 17 =. N E IN S 8 W H OF e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NE SUNSET BLVD MILEPOST ST e✓ 1200 ❑ 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �,❑ FEET e S ❑ W e EDMONDS AVE NE 0 3 29 MOTUNIT U1 VEHIOR PI PEDAL-CLE CYCLE ElYESAGE THRESHOLDNO MET PHONE 0 1 30 LAST NAME MORENO RODRIGUEZ FIRST NAME KEYBELL MIDDLE U 6 INITIAL 1 2 31 STREET ❑ 1150 UNION AVE NE 11-6 CITY RENTON ST WA Zjp, 98059 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET U E 9 CLASS 1 NATURE OF INJURIES z❑ 3 LICENSE CER1974 sTATI WA urN# 10❑ PI ATE 14 11[—jTRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# IR.. ro TRLR. TRLR. 5 3 33 12 3 5 VIN#' VIN# FROM TO VEH.YEAR 2018 MAKE KIA MODEL SPORTA STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 DAMAGE YES NO YES[:] NO✓ 13❑ REGISTERED OWNER INFO KEYBELL MORENO RODRIGUEZ 1150 UNION AVE NE 11-6 RENTON 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEH" CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4252561693 16 a LAST NAME DRON FIRST NAME NICK MIDDLE G INITIAL 17 STREET NEW ADOREsS❑' 13312 189TH AVE SE CITY RENTON ST WA ZIP 980597222 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 DRIVER # INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ LICENSE I ❑21❑ PLA E# CHM6451 TATe 41 WA VIN# YV1SZ58D021077817 4 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I VEH YEAR 2002 MAKE VOLV MODEL V70 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO GENE MEYERS YES NO REGISTERED OWNER INFO NICK DRON 13312189TH AVE SE RENTON WA 98059 VEHICLE NO.2 SHADE DA GEbAREA LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY INS 4101139277-63 IGQI IN EFFECTVE""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 s � e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 J.M/TCHELL 10377 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE02083 COLLISION REPORT III III III III III 111 1591972 CASE# 23-10790 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' On 091923 1 responded to a collision involving 3 vehicles. The collision occurred on NE Sunset Blvd at Edmonds Ave NE. I contacted the driver of unit 2 who told me they were traveling eastbound in the #1 lane of NE Sunset Blvd when they were hit by unit 1. Driver of unit 2 says unit 1 pulled out onto eastbound NE Sunset Blvd from northbound Edmonds Ave NE. After being hit on the passenger side of their vehicle, driver of unit 2 ricocheted into unit 3 which was traveling eastbound in the #2 lane of NE Sunset Blvd. Unit 2 sustained damage to the rear right wheel/tire along with passenger side door damage and front left bumper damage. I contacted the driver of unit 3. Driver 3 confirms they were hit by unit 2 while traveling eastbound in the #2 lane. Also confirmed the driver of unit 1 exited the vehicle briefly, looked at both vehicles involved and then drove off eastbound on NE Sunset Blvd. Unit 2 sustained right side damage as a result of the collision. Approximately an hour later, I was contacted by the brother of the driver of unit 1 due to limited English (Spanish primary language). I was told the driver of unit 1 drove further east on NE Sunset and pulled into the Safeway parking lot (2900 block). Driver of unit 1 issued citation for Failure to Yield. But not for the action of UNIT 1 DRIVER the result would not have happened. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J.MITCHELL 09-19-23 04:10 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 9/25/2023 9:56:40 AM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 2:25 Pry] TIME POLICE ARRIVED'2:30 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE02083 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-1o790 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:4255779988 ] OF 1 Zg LAST NAME LUTHER FIRST NAME CARLA MIDDLE' E r:j INITIAL STREET 30 NEW AnDRFSP 4456 334TH PL SE CITY FALL CITY ST WA ZIP 980245800 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv', 07 - 23 - 1947 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BOK7413 TAr Wq VIN# 1YVHZ8BH9B5M22133 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2011 MAKE MAZD MODELMZ6 STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO CARLA LUTHER 4456334TH PL SE FALLCITYWA98024 ] $ 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO yARP 55PHT760889 grOp IN EFFECT I POLICY# 1 EHICLE o BarroM 34 13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STRE 16 NEW ETETnnR"� CITY ST ZIP CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LecALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J,MITCHELL 09-19-23 04:10 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10377 O#I',WA0171300 JACOBS 9/25/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE02083 CASE# ' 23-10790 DATE AND TIME 09/19/23 14:25 OF COLLISION r NE SUNSET BLVD EDMONDS AVE NE PAGE 4 OF 4