HomeMy WebLinkAbout24-04023 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-04023 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 1601 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 12TH ST BLOCK NO. e✓ 2600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e S ❑ E e HARRINGTON AV NE❑
Fill
1 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:6158038214 0 11
30
LAST NAME HERNANDEZ VELAZCO FIRST NAME ALDAIR MIDDLE N
6 INITIAL 1 2 31
STREET El 24440 RUSSELL RD APT 115 CITY KENT ST WA Zjp, 980324279 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER # STATE WA SEX'M MD.
M DI,Y' 04 - 14 - 1997 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS
ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE 14 A7117892 STATE WA u N#' 1 FADP3E25EL 112328
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
TRLR. TRLR 9 1 33
12 3 0 VIN#' VIN#
:: FROM TO
VEH.YEAR 2014 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 FORD FOCUS SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO BEATRIZ VELAZCO ZAPOT 24440 RUSSELL RD APT 144 KENT WA 980324281 D:2067786398 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
2 3 4
14 4 LIABILITY INSURANCE INSURANCE CO ALLSTATE 820215502
IN EFFECT &POLICY# 9TOP 5
vEHICLe CHARGE 10 BOTTOM 36
15❑ _A'LLLNG YES No CITATION# 4A0313565,4A0313565 NO VALID OPER LICENSE WITH e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068560045
16 a
LAST NAME GONZALEZ FIRST NAME ABRAN MIDDLE A
INITIAL
17❑ STREET ❑', 14040 24TH AVE S CITY SEATAC ST WA ZIP 981683820 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 F] LDI IVER # STATE WA SEX M M D.C.B. 09 _ 28 _ 2003 El 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21❑ LICENSE I CDK5653 TATe WA VIN# 1HGCG16502A068119
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2002 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ABRAN GONZALEZ 801 S 14TH STAPT 6 TACOMA WA 98405 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY INSURANCE❑ INSURANCE CO NO PROOF
IN EFFECT &POLICY# I VE-LF s Nc❑ CITATION# 4A0313566 CHARGE OP MOT VEH W/OUT INSURANCE
25 GQ
...Lr
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68249
COLLISION REPORT III III III III III 111
1591972 CASE# 24-04023
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'
Unit 1 parked along curb on the south side of the 2600 block of NE 12th St, facing east near
Harrington Av NE. Unit 2 traveling east along the 2600 block of NE 12th St. Unit 1 fails to yield right of
way when entering roadway from a parked position. Unit 2 collides with Unit 1 causing reportable
disabling front passenger side damage to Unit 2 and reportable disabling front driver side damage to
Unit 1. No injuries reported. Unit 1 initially reported that RO was the driver during the collision.
However Unit 1 actual listed driver admitted that he was driving. Unit 2 driver reported that he had
valid insurance through his mother. However Unit 2 driver could not provide proof of valid insurance
on scene. A check of Unit 1 driver's name through WA DOL listed him as ID only with no valid driver
license. Unit 1 reported that Unit 2 was speeding which they believed was a factor in the collision.
However, Unit 1 still failed to yield ROW. Unit 1 driver was cited for NVOL w/ID and failture to yield
ROW. Unit 2 driver was cited for no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 04-12-24 05:28 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIREE SCOTT 10272 4/15/2024 11:45:52 AM
BADGE OR ID# 12651 ORI#' i WA0171300 TIME POLICE DISPATCHED; 4:07 Pry TIME POLICE ARRIVED{4:16 PM
PART I PAGE IT]OF
REPORT NO. EE68249 CASE# ' 24-04023 DATE AND TIME 04/12/24 16:01
OF COLLISION
9
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70,E 1-
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