HomeMy WebLinkAbout24-2030 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 24-2030 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 02 - 1-- 2024 1306 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE NE BLOCK NO. e✓ 440
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:5613447435 0 3 30
LAST NAME MONCADA PEREZ FIRST NAME YARITZA YABADY MIDDLE
6 INITIAL 1 1 2 31
STREET ❑✓ 24035 SE 262 STREET CITY MAPLE VALLEY ST WA 2jp, 98038 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
� ON DUTY❑ STATUS' AIRBAG' 2 RESTR 4 EJECT 1 H LMETUSE CLASSY
'7 C[NATURE
LIRE OF IJ
IN URIES 2ICENSE1 ❑
3
10 9� PI ATE 14 CKA2088 STATE WA VIN# 5NPE24AF4HH478267
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 5 1 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 1 34
13 4 HYUN SONATA P4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ANTONIO QUESADA URIBE 8558 NESBITAVE N#210 SEATTLE WA 98103 D:4706528181 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VE— CHARGE 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ NDING Ka 7
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
U
NIT U2 VEHICLE ❑ CYCLE ❑ ❑ PROPOWNER ❑ YES1/ No D:2066534153
16 a
LAST NAME YlP FIRST NAME GORDON NEGAI-FLING MIDDLE
INITIAL
17 STREET❑ NEW ADDREss❑' 975 JERICHO PL NE CITY RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK yEEsI I I NOF YEs t l NO�
19 DRIVERS
# STATE WA SEX M Mr D.C.B. 01 09 _ 1976 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AFC9204 TATE WA VIN 1 41
STDBK23C88S018680 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2008 MAKE 7'Dy7' MODEL SIENNA STYLE VN DAMAGE TOWED NOO✓ BLIN TOWED BY ovHyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 920952516IN STOP 5
VE"LE ❑ Nu,J CITATION# CHARGE
25 to BOTTOM
LEGALLY YES ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE53474
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2030
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 2/24/24 around 1306 hours I was dispatched to the 450 blocks of Union AVE NE (City of Renton,
County of King, and State of Washington due to a report of a vehicle collision. Upon arrival I
contacted Driver#1 who stated she was traveling North bound on Union AVE NE when Driver#2
pulled out of the Chase Bank Parking lot to take a right-hand turn onto Union when Vehicle #2 struck
her Vehicle #1 was struck on the passenger side rear door, quarter panel and wheel, and caused the
rear bumper to break off. Driver#1 complained of chest pain and was evaluated by Renton Fire
Department. Driver#1 did not have insurance but had a Venezuela driver's license. Pictures were
taken of her driver's license and damage to vehicles.
Driver#2 stated he was facing Westbound in the exit to go onto Union from the CHASE bank, and
was making a right-hand turn onto Union to go North bound when he pulled out he struck vehicle #1.
rear passenger door. Driver#2 said that Vehicle #1 was traveling too fast in its lane, and he didn't
even see it until he made the turn. Driver#2 did not report any injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
DESIRES SCOTT 02-24-24 03:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 2/24/2024 3:14:48 PM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED 4:08 PM TIME POLICE ARRIVED 1 1:10 PM
PART I PAGE IT]OF
REPORT NO. EE53474 CASE# ' 24-2030 DATE AND TIME 02/24/24 13:06
OF COLLISION
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