HomeMy WebLinkAbout24-4104 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE68501 170
27
COLLISION REP FIT 1591971
SASE 24-4104 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 0730 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DUVALL AVE NE BLOCK NO. e✓ 1600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S B W e NE SUNSET BLVD
2 0 29
R PEDAL- DAMAGE
MOTO THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO F/ I D:2065961910 0 11
30
6� LAST NAME RAMIREZ FIRSTNAME ENRIQUE MIDDLE A 1 2 31
INITIAL
STREET 01 303 PARK AVE N#R CITY RENTON ST WA 2jp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER # STATE WA SEX'M MI D Y' 12 - 22 - 1997 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE CO26595 sTATI WA VIN# 54DCDW1BOKS808842
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN I
TOWED By GOVT.VEHCLE 5 1 34
13 2 2019 CHEV 4500 ST DAMAGE YES fn TO YES[:] H
REGISTERED OWNER INFOANGKORLANDSCAPE3204THAVES ALGONA WA98001 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO TRAVELERS 2R858620-BA 3 4
IN EFFECT &POLICY# 9TOP
VE'C CHARGE 1 5 36
ALLv YEs No CITATION# 4AO131304 IMPROPER LANE USAGE o aorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252217646
16 a
LAST NAME MORENO ZELEDON FIRST NAME ULISES MIDDLE
INITIAL
17❑ STREET ❑', 1150 UNION AVE NE 11-06 CITY' RENTON ST WA ZIP 98059 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 F] DRIVER'S STATE WA SEX M D.C.B. O6 1_ 26 _ 1972 El 39
LICENSE# MMDDYY
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21❑ LICENSE I CDN3989 TATe WA vIN1t JN8AZ1MW4EW509435
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2014 MAKE j11I$S MODEL MURANO STYLE 4H DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&POLICY#E CO SAFECO H2413720IN IGQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68501
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4104
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 2 northbound on Duvall Ave NE lane 1 after turning left from NE Sunset Blvd. Unit 1 changing
lanes from lane 2 to lane 1 to pass traffic stopped behind a Metro bus. This carried unit 1 into path of
unit 2, causing the right front fender area of unit 2 to contact the left front wheel and bodywork behind
it on unit 1. Driver 1 Ramirez told me that he had looked back and had not seen any traffic in lane 1
before moving over, but video from an adjacent store showed that unit 2 was already passing unit 1
when Ramirez started to move over.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 04-15-24 12:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 4/16/2024 3:54:27 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED'; 7:39 AM TIME POLICE ARRIVED 7:53 AM
PART I PAGE IT]OF 3�
REPORT NO. EE68501 CASE# 24-4104 DATE AND TIME 04/15/24 07:30
OF COLLISION
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