HomeMy WebLinkAbout23-11305 IT ' " . 27POLCERAFFO 1 c REPORT NO EE19081
COLLISION REP FIT
1591971
CASE 23-11305 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 10 - 1-- 2023 0746 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e✓ 500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e N 6TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532611704 0 11
30
6� LAST NAME EA TON FIRSTNAME JOSEPH MIDDLE A 1 1 2 31
INITIAL
STREET 01201 SCHMID ST CITY ENUMCLAW ST WA 2jp, 980227437 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
�/ I INTERLOCK YES[:]No NTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 P1 ATNES# 448UKL sTAT WAV N# JTHBD192420040395
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. TRLR 1 3 33
12 3 0 VIN#' VIN#I
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13� 2002 LEXS IS 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO JOSEPH EATON 201 SCHMID ST ENUMCLAW WA 98022 D:2532611704 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE E CO DAIRYLAND 11407736760 <1�3 4
LI EFFECTISUR N# TOPVEHICLE CHARGE 36
LEGALLY YES NO CITATION# 3AO463532 INATTENTIVE DRIVINGorroM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:3238531671
16 a
LAST NAME SUASTEGUI DOMINGUEZ FIRST NAME NELSON MIDDLE I Y
INITIAL
17 NEW STREETREs7' 512 23RD ST SE APT C CITY AUBURN ST WA ZIP 980027646 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES t t- l NO❑
19 D IVEW #
❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# BXH2568 TATE WA VIN# 41
4T3ZF13C7YU174382 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2000 MAKE TOYT MODEL SIENNA STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NELSON SUASTEGUI DOMINGUEZ 51223RD ST SE APT C AUBURN WA 98002 D:3238531671 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO DAIRY LAND 11408142856IN 1Cal
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE19081
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11305
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 10-3-23 at about 0755 1 arrived in the 600 block of Logan Ave N for a 2-vehicle collision. I
contacted both vehicles and their drivers in a nearby parking lot. Both drivers were identified via
WADL. Driver 1, Joseph Eaton told me;
He was making a left turn into the parking lot from southbound Logan Ave N.
He thought he had a clear path to make his turn and collided with unit 2 as it was Northbound in lane
1 of Northbound Logan Ave N.
He was not injured.
There were no injuries reported. I cited Eason for Drivers Inattention via complaint.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 10-24-23 08:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1111312023 9:27:32 AM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 7:51 AM TIME POLICE ARRIVED',7:55 AM
PART I PAGE IT]OF 3�
REPORT NO.! EE19081 CASE# 23-11305 DATE AND TIME 10/03/23 07:46
OF COLLISION
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