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HomeMy WebLinkAbout24-10673 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-10673 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING' COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#TRIBAL OF 02 OBJECT 1 1 8 28 UNITS RESERVATION I STRUCK z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# CawsloN 10 - 1-- 2024 1944 17 ❑.= S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 30TH ST BLOCK NO. e✓ 1600 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ � MILES,❑ FEET e S ❑ E e KENNEWICK PL NE 0 1 29 MOTOR ✓ PEDAL- DAMAGETHRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs NO ,/ D:4253816324 0 1 30 g LAST NAME NUNEZ SIERRA FIRST NAME JOSE MIDDLE F 1 1 2 31 INITIAL STREET ❑ 1090420 ST SE CITY LAKE STEVENS ST WA ZIP 982584747 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ DRIVERS # STATE WA SEX'M I D-MIDI Y' 03 — 08 — 1982 1 2 32 9❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10 2❑ P1 aT�S� C01145T sTAr� WAurN# 1FTRF12W48KF07464 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM ro TRLR. TRLR. 5 1 33 12 2 5 vIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13FA 266W FORD F150 PK DAMAGE YES NO YES❑ NoF,/1 I REGISTERED OWNER INFO SIERRA&SON ROOFING LLC 1090420TH ST SE LAKE STEVENS WA 98258 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO GEICO 4277371573 3 4 IN EFFECT &POLICY# 9TOP VE—LE 5 36 LEGALLY Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4258912092 16 a LAST NAME QUINTEROS POLIO FIRST NAME RUDI MIDDLE F INITIAL 17 STREET❑ NEW ADOREss❑' 2907 NE 6TH ST CITY RENTON ST WA ZIP 980563727 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YES�NOR INTERLOCK YEs W�1 I NOF YES t l NOF,/ 19 DRIVER'S STATE WA SEX M D.O.B. 05 _ 02 _ 1989 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 4 RESTR 4 EJECT 1 H EET 2 NJAU EY 6 TIGHTNESS F—NATURE OF JlN NECK AND BACK ❑URIES 40 ❑ILICENSE 21❑ PLA E# APC7905 TArE 41 WA vIN# 1N4AL2AP9CN543072 1 42 22❑ PLATE# STATE PLATE# STATE T 23❑ 43 IN# IN RLR #.UIN#. ' VEH YEAR 2012 MAKE NISS MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO CELSA TRUJILLO 2907 NE 6TH ST RENTON WA 98056 VEHICLE NO.2 SHADE IN DAG�AGE$AREA 2 L3 �d LIABILITY INSURANCE &POINSURGY#E CO PROGRESSIVE 939568401IN I STOP 5 VE'LLE YES❑ N J ,J� CITATION# CHARGE i o BOTTOM LEGALLY 25 s � e =AS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 GOODWIN 12884 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF251 16 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10673 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 PM 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' 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. NICHOLAS GOODWIN 10-12-24 09:18 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 1011612024 4:27:05 PM BADGE OR ID# ! 12884 (DR]# WA0171300 TIME POLICE DISPATCHED; 7:44 PM TIME POLICE ARRIVED',7:57 PM PART B PAGE IT]OF 4� REPORT NO. EF25116 CASE# 24-10673 FC LNaoy L isI©�ON O 10/12/24 19:44 F cu NARRATIVE 24-10673 Unless otherwise noted, the following took place within the city limits of Renton, County of King, WA. On 10/12/2024 at approximately 1948 hours I was dispatched to a non-injury, non-blocking collision at the Arco AMPM, located at 1616 NE 30th St. Dispatch advised both vehicles pulled over onto the south side of the road and there is over $1,000 of damage. I arrived on scene, contacted both parties and gathered the following: Unit 1 was identified as the white 2008 Ford F150 bearing WA/C01145T, driven by Jose F. Nunez Sierra (03/08/1982). Jose was not complaining of any injuries. I observed moderate damage to the front bumper towards the driver's side. Jose advised he was stopped at the stop sign on the NB 1405 off-ramp, facing northbound. Jose did not observe Unit 2 traveling eastbound through the intersection on NE 30th St. and proceeded into the intersection. Jose advised he collided with Unit 2 and understood he was at fault. Unit 2 was identified as a maroon 2012 Nissan Altima bearing WA/APC7905, driven by Rudi F. Quinteros Polio (05/02/1989). Rudi was complaining of tightness in his back and neck. I requested RRFA respond to the scene to evaluate Rudi. Following RRFA's evaluation, they advised Rudi did not need further medical attention at a hospital. I observed damage to the rear passenger side door of Unit 2. There was also airbag deployment on the passenger side of the vehicle. Rudi advised he was traveling eastbound on NE 30th St and proceeded through the intersection of the 1405 on/off ramps. While in the middle of the intersection, he was struck on the passenger side of his vehicle. Speeds were minimal as both vehicles were stopped at stop signs. Both vehicles were drivable, and no tows were needed. Neither party was cited following the collision. Both parties received copies of the case number and information was exchanged. Nothing further. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer N. Goodwin 12884 at 2053 hours on 10/12/2024 in Renton, WA. PAGE 3 OF 4 REPORT NO. EF25116 CASE# 24-10673 DATE AND TIME 10/12/2419:44 OF COLLISION t j e i y Zvi t x { Y` 3� t� tit 1 a t �,x S } } I P PAGE 4 OF 4