HomeMy WebLinkAbout24-3646 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3646 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&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# ❑
COLLISION' 04 - 1-- 2024 0200 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 12TH ST BLOCK NO. e✓ 2603
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:9092722714 1 4 30
LAST NAME ZAPATAPANIAGUA FIRSTNAME KEVIN MIDDLE J
6 INITIAL 1 2 31
STREET 01 1211 JEFFERSON AVE NE CITY RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
❑ DRIVER'S' STATE CA SEX'M MELO B 10 - 12 - 1991 32
8 LICENSE#
9 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELM
U EET CLA NA
Y 1 [!!RE OF INJURIES 2❑
❑ 3
10 F] PI ATE 14 9KOR298 STATE CA VIN# 5NPE24AF6GH407893
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# Rom ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
Rom 34
13❑ VEH.YEARN MAKE HYUN MODEL SONATA STYLE SO VEHICLETOWED0NOOffBLIN TSIgWgYMEYER v�s❑ENo�
DAMAGE IILLJJII (��IV6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
�: 3
14 LIABILIT INSURANCE❑ INSURANCE CO ��qq�
IN EFFECT &POLICY# OOP
VEF'C CHARGE 10BOTTOM ❑ 36
15❑ LEGALLY YEs No CITATION# gg0351905,4A0351905, NO VALID OPER LICENSE WITH 2
UNIT VE IMOTOOR Z CYCLE ❑ PEDESTRIAN ❑ OWNER
PROPERTY [:]I
DYES NO SOLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY TACOMA ST ZIP $
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NoF,/
19 LLIICENS RIVER# SEX U MMDDYY 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
LICENSE I ❑21❑ PLA E# CBT7655 TATe WA VIN# YV 41
1CZ911451155306 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2005 MAKE VOLV MODEL XC90 STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CINTIA GARCIABOCANEGRA 1834 E 32ND ST TACOMA WA 98404 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65447
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3646
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 NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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.
STEVEN FAJARILLO 04-04-24 03:48 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
MICAELA CASTAIN 12573 1 41412024 11:59:50 PM
BADGE OR ID# 1Y847 OR]# WA0171300 TIME POLICE DISPATCHED 2:02 AM TIME POLICE ARRIVED 2:03 AM
PART I PAGE IT]OF 4�
REPORT NO. EE65447 CASE# 24-3646 OF COLLISION
04/04/24 02:00
OF CbLLI510N
NARRATIVE
24-3646
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 04-04-2024 1 was working as a police officer in the city of Renton. At approximately 0203 hours I
was dispatched to the report of an unknown collision at 2603 NE 12th St, City of Renton, County of
King, WA. This incident was captured on my department issued Axon body camera.
Unit 1 was identified as a red 2016 Hyundai Sonata (CA/9KOR298) (Unit 1). Unit 2 was identified as a
whit 2005 Volvo XC90 (WA/CBT7655) (Unit 2).
Unit 1 was travelling west at the 2600 NE 12th St at approximately 20 miles per hour. Unit 2 was
parked on the north side of NE 12th St facing west. Unit 2 was unoccupied and legally parked. There
was no traffic control where the collision occurred. There were no traffic cameras in the area.
The front end of Unit 1 collided with the rear driver side wheel and quarter panel of Unit 2. Unit 1
flipped over onto its roof in the middle of the road. Unit 1 sustained serious damage and Unit 2
sustained minor damage. Unit 1 had a combination of side and front airbag deployment. The driver of
Unit 1 stated he was uninjured and was treated on scene by Renton Fire. The driver of Unit 1 was the
only person involved in the collision.
I called the original reporting party, who advised she only heard the collision and possibly saw a male
outside of Unit 1. There were no other witnesses to the collision.
Unit 1 was towed privately by Gene Meyer Towing. I provided each party with a case number.
I completed a notice of infraction (#4A0351905) to the driver, Kevin J Zapata Paniagua (DOB:10-12-
1991). 1 completed a citation for no proof of insurance, no valid operator license with identification,
and improper lane usage.
Unit 1 drove his vehicle into a legally parked car on the side of the road. Unit 1 did not maintain its
lane position making this the proximate cause of the collision.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 04/4/2024 @ 0330 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EE65447 CASE# 24-3646 DATE AND TIME 04/04/24 02:00
OF COLLISION
a
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