HomeMy WebLinkAbout24-3944 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3944 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 7 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 - 11 - 2024 0740 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e HARDIEAVESW
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2063512565 0 3 30
6� LAST NAME ANGLE FIRSTNAME JAMI MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 13157175TH AVE E UNIT G4 CITY
BONNEY LAKE ST WA 2jp, 98391 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 04 1— 30 — 1979 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 2❑ PI ATE B 4 Af23325 JBTATIJ WA u N# WBAPH7C52AE125882
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
FTRL-R TPILF1 1 5 33
12 2 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 6 34
13❑2 2010 BMW 328 4D DAMAGE YES NO YES[:] ✓No
REGISTERED OWNER INFO JAM/SMITH 13117175THAVEE UNITG4 BONNEYLAKE WA 98391 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO GEICO 4310-00.46.03 3
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 5 36
LECALLv Ye6❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO PHONE
2062343101
16 a
LAST NAME EBALO FIRST NAME RENATO MIDDLE I D
INITIAL
17❑ STREET ❑', 8409 S 119TH ST CITY SEATTLE ST WA ZIP 981784036 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 29 _ 1951 0 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE AHC6511 TAre WA vIN# 5J6RM41133CL018216
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2012 MAKE HOND MODEL CR-V STYLE 4H VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO RENATO ESALO 8409 S 119TH ST SEATTLE WA 98178 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8POINSURGY#ECO STATE FARM 3976467-F28-47IN 1 VEHICLE II CITATION# CHARGE
25 UQ,
LEGALLY YES N
7.FF1CJEO-S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68581
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3944
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) EBALO EMILYB
(IAST FIRST,
ADDRESS&PHONE# D O.B.
8409 S 119TH ST SEATTLE WA 981784036 SEX F MMDDYyry 11 - 11 - 1970
PASSENGER Z WITNESS❑'UNIT# 1 2 SEA 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET I INJURY NATURE OF INJURIES
USE CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) EBALO MEGAN
ADDRESS&PHONE# Ly I .0 B.
8409 S 119TH ST SEATTLE WA 98178 SEX F MMDDYyYY 10 _ 21 _ 2005
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER Z WITNESS UNIT# 2 PCS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
CO.JOHNSON 04-11-24 09:49 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 4/16/2024 7:50:39 AM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED; 7:51 AM TIME POLICE ARRIVED:8:01 AM
PART I PAGE IT]OF 4�
DATE AND
TIME
REPORT NO. EE68581 CASE# 24-3944 OF COLLISION04/11/2407:40
NARRATIVE
U1 SB RAS Ln #2 to In #1. U2 SB Hardie Ave SW to RAS Ln #1
On 04-11-2024 at about 0751 hours, I was dispatched to collision that occurred in the 700 block of
Rainier Ave S in the City of Renton, County of King, Washington State. The vehicles were not
blocking and now in front of a gas station in the area. I arrived at about 0801 hours and observed
both vehicle stopped on the south side of the entrance to Walmart. Due to the close proximity to
vehicles exiting Rainier Ave S, I instructed the drivers to move their vehicles further into the parking
lot.
The driver of Unit 01 was identified by WA DL and admitted to driving the listed vehicle. The driver
said she was not injured as a result of the collision and was wearing a seatbelt when the collision
occurred. The driver indicated she was southbound of Rainier Ave S in lane #2 and intended to
change lanes to the right to enter lane #1 for a future right turn. When she entered lane #1 her
vehicle was struck by Unit 02. The driver said she saw Unit 02 driving way back in the bus only lane
(lane #1).
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was not injured as a result of the collision and was wearing a seatbelt when the collision
occurred. The driver indicated he was driving southbound on the side street (Hardie Ave SW) with
the intent to turn right onto Rainier Ave S. After making the turn onto Rainier Ave S, Unit 02 was hit
by Unit 01. 1 asked the driver if he was driving in the bus lane on Rainier Ave S before the collision
and he replied he was not.
I observed moderate damage to the passenger side quarter panel of Unit 01 and the driver side
fender of Unit 02. The damage consisted of paint transfer, scrapes and rub marks. Based on the
amount and location of the damage, it appeared both vehicles had a similar orientation and Unit 01
was further south on the roadway when the collision occurred. Due to the different accounts from the
drivers of the vehicle locations prior to the collision, I was unable to determine if either unit was
established in lane #1 prior to the collision occurring.
No infractions or citations issued. Report for information and insurance purposes.
PAGE 3 OF 4
REPORT NO. EE68581 CASE# 24-3944 DATE AND TIME 04/11/24 07:40
OF COLLISION
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PAGE 4 OF 4