HomeMy WebLinkAbout24-2894 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-2894 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 03 - 1-- 2024 2343 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 180TH ST BLOCK NO. e --- ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e EAST VALLEYHWY
0 1 29
UNIT MOTOR
PI PEDAL-
CYCLE El DAYESMAGE NHORESHOLD MET PHONE 01 0 8 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8 DRIVER'S. STATE SEX.U D.Q.B. 1 1 2 32
❑ :LICENSE# MMDDYY —❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR m 33
12 0 0 VIN If VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R 9 34
13❑ DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe 1 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO %/ RO 2069460766
16 a
LAST NAME FERNANDEZ FIRST NAME MARIA MIDDLE It
INITIAL
17 STREET ADORE66❑' 16808 106TH AVE SE CITY RENTON ST WA ZIP 98055 37
� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO
19[—] DRIVER'S STATE WA ]SEX IF I D.O.B. 11 07 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CKW5139 TATE WA VIN# 41
JTNKHMBX8K1057669 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE TOYT MODEL C-HR STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARIA FERNANDEZ 16808106TH AVE SERENTONWA98055 D:2069460766 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP
vE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
N AAH G/RELLO 12607 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE61839
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2894
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NOAH GIRELLO 03-18-24 01:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 3/23/2024 4:11:45 PM
BADGE OR ID# 12607 ORI# WA0171300 TIME POLICE DISPATCHED 11:45 PM TIME POLICE ARRIVED',11:50 PM
PART Ei PAGE IT]OF
REPORT NO. EE61839 CASE# 24-2894 OF COLLISION
03/16/24 23:43
OF CbLLI510N
NARRATIVE
24-2894
At about 2345 hours on 03/16/2024 1 was dispatched to a hit and run accident at, S 180TH ST/ East
Valley HWY, in the city of Renton, King County, Washington. Dispatch advised me that about five
minutes prior to the time of call there was a three-motor vehicle accident and one driver involved was
complaining of neck pain.
Upon may arrival, Renton Fire Department was already on scene doing an evaluation with the driver
complaining of neck pain. When I arrived all involved had pulled into a nearby gas station. Both
drivers still on scene advised that the at fault driver, unit 1 had fled the scene after figuring out that
the other units involved were calling the police. Both units 2 and 3 described the vehicle that took off
as an older blue chevy sedan, driven by a black male wearing a black beanie. The driver of unit 2
took a photo of the vehicle before it left and captured a paper temporary plate in the window. That
plate was LIC/A5911436, which came back to a 2012 jeep compass and was definitely not the vehicle
the temp plate belonged on.
The following is a summary of what unit 2 said happened. The driver of unit 2 was the sole occupant
of the vehicle when she was stopped at a red light in the #1 lane, east bound on S 180th ST. The
driver of unit 2 advised she did not see unit 1 coming before unit 1 hit her from behind as she was
stopped. After being unit 2 said that unit 1 pulled over to the gas station to exchange information. Unit
2's vehicle had very minor, suspected cosmetic only damage to the rear passenger side of the
vehicle. The drive of unit 1 was the driver complaining of neck pain. Renton Fire Department
evaluated the driver and cleared her of any injuries requiring immediate attention.
The following is a summary of what unit 3 said happened. The driver of unit 3 was the sole occupant
of the vehicle when he was stopped at a red light in the #2 lane, set up to go east bound on S 180TH
ST. The driver of unit 3 advised after unit 1 hit unit 2 first, unit 1 veered off clipping unit 3 on the rear
driver's side of the vehicle. Unit 3's vehicle had very minor damage and the driver had no complaints
of pain or injury.
Both drivers were able to driver their vehicles away after the incident and there was no further
information on the suspect or his vehicle. There were no other witnesses to the accident and other
then the traffic cameras I did not observe any security cameras.
Unit 2 and 3 did not have proof of insurance at the time of the accident.
This incident was captured by my body worn video camera. This report is a summary of the events
that occurred and is not an exact sequencing of events. Statements have been summarized and
paraphrased.
This concludes my involvement with this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by N. GIRELLO #12607 on 03/17/2024 at 2000 Renton, WA
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE61839
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-2894
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE _) PEDESTRIAN � OWNER � YES NO
D:2533918584
rFO 8 29
LAST NAME CHILDS FIRST NAME KEVYN MIDDLE' L
INITIAL
STREET 30
NEW AnDRFSP 23312 112TH AVE SE CITY KENT ST WA ZIP 98031
6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs NO NTERLOCK YES❑N0� vES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 12 - 17 - 1979
7
ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE C30036Y TAr Wq VIN# 1GCGK13UO3F166405
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2003 MAKE CHEV I MODELSILVERA STYLE VEHICLE TOVVE ET SABLIN TOWED BY anvi vEH1CP FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFOKEVYN CHILDS 23312112TH AVE SE KENT WA 98031 D:2533918584 J 9 33
12 � SHADE IN DAMAGED AREA
3 4 FROM TO
LIABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# 1 9 1"01?
VEHICLE 34
13 ❑ LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM
STANDING } 8 7
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
NTERLUCK YES No NTERLOCK YEs NO YEs NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAr VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
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 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGAtty
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.
NOAH GIRELLO 03-18-24 01:51 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OI BADGE 12607 O#I',WA0171300 SCOTT 3/23/2024 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. EE61839 CASE# 24-2894 DATE AND TIME 03/16/24 23:43
OF COLLISION
4
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PAGE 5 OF 5