No preview available
HomeMy WebLinkAbout24-9971 TFFiNouCERA II I l�� I III � I III I �IIII III II I . 6 27c COLLISION REP FIT 1591971 SASE 24-9971 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HIT& F ❑ LOCAL AOENC 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ 1 1 8 28 TOTAL#OF OBJECT i TRIBAL ': UNITS 03 STRUCK WOOD SIGN POSF RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION: 09 - 1-— 2024 0932 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 10TH ST BLOCK NO. e✓ 3000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FMILES EET e S ❑ E e KIRKLAND AVE NE 0 1 29 MOTOR PEDAL- DAMETHRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE. ElYES AG✓NO D:2532596902 0 1 30 LAST NAME ANGELINA MARTINEZ FIRST NAME ANDREW MIDDLE J 6 INITIAL 1 2 31 STREET ✓ 407 VALLEYAVE NE#M205 CITY PUYALLUP ST WA ZIP 98372 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NOW INTERLOCK YES NO YES R No 8❑ DRIVERS # STATE WA SEX'M I ELMIDI Y' 11 — 12 — 2002 1 2 32 9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 1HELM U EET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 2❑ PI ATF SE 14 CKZ1522 JJ STATE WA u N# JTDKN3DU8A0158600 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM ro TRLR. YRLR. 5 1 33 12 0 0 VIN#j VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 3 34 13 2 2010 TOYT PRIUS 4D DAMAGE YES NO �LII� RS vEs❑ No REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 rI LIABILITY INSURANCE❑ INSURANCE CO NONE 3 4 IN EFFECT &POLICY# STOP ❑ LEGA LE CHARGE 5 36 15 2 VEH'C ITA"N YES❑No CITATION# 4A0719158 OP MOT VEH W/OUT INSURANCE o aorrob MOTOR PEDAL- PEDESTRIAN PROPERTY DAM NO OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2062903693 16 a LAST NAME CROCKER FIRST NAME DWIGHT MIDDLE J INITIAL 17❑ STREET Is�' 17220 ASHWORTH AVE N CITY SHORELINE ST WA ZIP 98133 4❑ 37 NEW ADOREs 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YEs❑NoF,/ 19 DRIVER # ON DUTY❑ STATUS AIRBAG,2 RESTR 4 EJECT 1 WEB C SET 2 NJAU�Y 6 LACERATION ABOVE RIGHT EYE F—NATURE OF INJURIES 40 ❑ILICENSE 21❑ PLA E# ARZ2121 TATE WA VIN# 41 3GNFK16T7YG219547 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 rRLR RLR VIN#. IN#. VEH YEAR 2000 MAKE CHEV MODEL SUBURB STYLE SV VEHICLE TOWED TO BLIN TOWEDev GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO CARA EDMUND 17220 ASHWORTH AVE N SHORELINE WA 98133 D:2062903693 VEHICLE NO.2 SHADE,IN DAMAGED AREA 4� 3 4 LIABILITY INSURANCE❑ INSURANCE CO NONE IN EFFECT &POLICY# STOP 5 VE""LE YEs Nc❑ cIrATION# 4A0719156,4A0719157 CHARGE DWLS 3RD DEGREE,OP MOT VEH ,osorroM LE...LY 25 ' a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 WILLIAM RIDGEWAY 12500 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICE TRAFFICN CORRECTION REPORT NO. ER 9218 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9971 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,FIRS 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. W/LLIAM RIDGEWAY 09-23-24 11:43 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 9/28/2024 4:29:14 AM BADGE OR ID# 12500 OR]# WA0171300 TIME POLICE DISPATCHED 9:33 AM TIME POLICE ARRIVED i 9:35 AM PART B PAGE IT]OF 5� AND REPORT NO. EF19218 CASE# 24-9971 OFCOLLISION 09/23/24 09:32 OF COLLISION�isi©�u NARRATIVE 24-9971 At about 0933 hours on 09/23/2024, 1 was dispatched to an accident with injuries at the intersection of NE 10th St and Kirkland Ave NE in the City of Renton, King County, Washington. The reporting party was a passerby. Upon arrival, I identified the (2) vehicles involved. Unit 1 was a blue 2010 Toyota Prius (CKZ1522/WA). The driver was the registered owner: Andrew J. Angelina-Martinez (D0B:11/12/2002 -verified by WADL photo). Unit 2 was a beige 2000 Chevrolet Suburban (ARZ2121/WA). The driver of Unit 2 was Dwight J. Crocker (DOB:05/26/1986 -verified by WADL photo). Per WA DOL return, Dwight was suspended and/or revoked in the 3rd degree. Both drivers were advised they would be recorded. Both were wearing their seatbelts. I observed Dwight with a laceration over his right eye. Dwight said he did not feel well and was sweating. I confirmed with dispatch that FIRE was enroute. Andrew said he did not have any injuries. No airbags were deployed in Unit 2. The driver's side airbag was deployed in Unit 1. FIRE arrived and evaluated Dwight. Dwight was advised he should seek further evaluation at the hospital, but he declined. Andrew reported some soreness on the back of his left shoulder. Unit 1 and Unit 2 advised they did not have insurance /were unable to provide proof of insurance. When asked what happened, Andrew said it was his fault. He said he (Unit 1) was traveling northbound on Kirkland Ave NE and did not stop at the stop sign at the intersection of Kirkland Ave NE. Unit 2 was traveling eastbound through the listed intersection, when Unit 1 struck the front right section of Unit 2, causing both vehicles to veer into the NE corner of the intersection. Unit 1 then struck a city owned stop sign, destroying the sign, before coming to a complete stop. Unit 2 said he was traveling eastbound, after stopping at the stop sign, when he was struck in the intersection by Unit 1. Unit 1 was undriveable and was impounded due to no insurance and unable to make payment. Unit 1 was blocking the intersection. I completed sector impound #24-9971. Unit 2 was pushed out of the intersection and parked along Kirkland Ave NE. Both parties were provided with a business card and case number. I confirmed both driver's current mailing addresses. Andrew was told he would receive a traffic infraction for no insurance in the mail. Dwight was told he would receive a criminal citation for DWLS 3rd, and a traffic infraction for no insurance. I gave a warning to Dwight about having expired tabs. Dwight said the registered owner was his wife. I took photos of both vehicles. Unit 1 had extensive front-end damage and was undriveable. Unit 2 had extensive front-end damage and noted the front grill was missing prior to the accident. Unit 2 would not start. The stop sign located on the east on the intersection on NE 10th was destroyed. The Renton signs shop was advised and a damage to city property form was completed. This concludes my involvement in this case. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by W. Ridgeway#12500 on 09/23/2024 at 1141 hours in Renton, Washington. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EF 1 9Z 1 H r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-9971 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE ❑ 1 28 2 CARRIER NAME 3 E] CARRIER L ADDRESS ` CITY ST' ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO D:4254307500 LAST NAME : CITY OF RENTON FIRST NAME MIDDLE.. 29 INITIAL STREET 30 NEW AnDRFSP' 1055 S GRADY WAY CITY RENTON ST WA ZIP 98055 6 II 1 31 CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T DRIVER'S STATE I SEX U M��DYSYv' -� 2 LICENSE 7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd I RE O CYDCLE � OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREET"[—] ❑ 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 a 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. WILLIAM RIDGEWAY 09-23-24 11:43 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26F7 OI BADGE 12500 O#I',WA0171300 APPROVED 9%2E8/2024 PAGE OF F 3000-345-013(R 11118) REPORT NO. EF19218 CASE# 24-9971 DATE AND TIME 09/23/24 09:32 OF COLLISION m, mt v ti � P in S 3 yy R s PAGE 5 OF 5