HomeMy WebLinkAbout24-2916 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE60140 170
27
COLLISION REP FIT 1591971
SASE 24-2916 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
cawsloN 03 - 1-- 2024 1845 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW SUNSET BLV BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2068502907 2 01
30
6❑ LAST NAME RICARDEZ FIRSTNAME SEAN MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 760 REDMOND AVE NE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MM D Y' 09 1— 15 — 1987 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� 1L1584M sTATI ID vIN# 1FDKE30L8EHC19802
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 1984 ELDO TRANSI CT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CRAIGRAY2129HENRYCT MOSCOWID83843 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
2 4
14 4 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
ve'CLE CHARGE 10 BOTTOM 36
LEGALLY YEs NO CITATION# 4A0199811,4A0199811, NO VALID OPER LICENSE WITH
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068417330
16 a
LAST NAME 1 77771SOONG-YAPLEE FIRST NAME PEGGY MIDDLE J
INITIAL
17❑ STREET ❑' 5110 S AUGUSTA ST CITY' SEATTLE ST' WA ZIP 98178 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs❑NoF YES❑NO❑
19 DIVE STATE WA SEX DDY
U M .C... 12 � 1952_ 30 _ El 39
HELMET I INJURY NATURE OF INJURIES 40
20� ON DUTY STATUS AIRBAG,2 RESTR 9 EJECT 1 USE CLASS 7 BACK PAIN ❑
21❑ LICENSE B73549T rare.WA VINtt 3TMMU4FN98M035832
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2011 MAKE TOYT MODEL TACOMA STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO PEGGY SOONG-YAPLEE 5110 S AUGUSTA ST SEATTLE WA 98178 D:2068417330 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO ECONOMY PREMIER INS.1363970260IN 1 9TOP 5
VEHICLE YES[:] ,.I— #I CITATION CHARGE i o BOTTOM
LEGALLY N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
YUSUF JIBRIL 12490 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE60140
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2916
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ACEVEDO LINDA S
(LAST FIRST,
ADDRESS&PHONE# D O.B.
5110 S AUGUSTA ST SEATTLE WA 98178 SEX F MMDDYyry 03 - 26 - 1949
PASSENGER Z WITNESS UNIT# 2 PEATOS 3 AIRBAG 2 RESTR. 9 EJECT ? 1 HELMET NATURE OF INJURIES
USE CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Ly Q
SEX' MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
YUSUF JIBR/L 03-17-24 10:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 311812024 12:03:51 PM
BADGE OR ID# 12490 ORI# WA0171300 TIME POLICE DISPATCHED', 6:50 PM TIME POLICE ARRIVED',7:00 PM
PART I PAGE IT]OF 4]
REPORT NO. EE60140 CASE# 24-2916 OF COLLISION
03/17/24 18:45
OF CbLLI510N
NARRATIVE
On 03/17/2024, at approximately 1852 hours, I was dispatched to investigate a collision at 700 blk of
SW Sunset Blvd. City of Renton, King County, State of Washington.
Upon arrival, driver of unit 2 was complaining of neck pain. RFA medic treated her on scene. Driver of
unit 1 and passengers did not report any injuries.
Both vehicles appeared drivable. Following account is based on the damages to the vehicles, the
drivers' statements and the evidence on scene.
Unit 1 and Unit 2 traveling westbound on the 700 block of SW Sunset Blvd. Unit 2 was traveling on
far right lane (lane 1) and Unit 1 was traveling on lane 2. Unit 1 improperly changed lanes and
collided with unit 2's driver side B-pillar.
Unit 1's registration was expired and the driver did not have a valid insurance. Additionally, the driver
of Unit 1 did not have valid driver license. The driver of Unit 1 was issued citation for driving without
valid driver license, operating motor vehicle without an insurance and for operating vehicle with an
expired registration.
Both drivers were provided with case number. I advised the driver of unit 1 to get a driver with valid
license to move the vehicle.
I certify under penalty of perjury under the laws of the state Washington that the foregoing is true and
correct.
Y.Jibril/ 12490 3/17/24, 1930 hours.
PAGE 3 OF 4
REPORT NO. EE60140 CASE# ' 24-2916 DATE AND TIME 03/17/24 18:45
OF COLLISION
IN
f �
�r
PAGE 4 OF 4