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HomeMy WebLinkAbout24-9468 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SAS 24-9468 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ vFFIIC;I F ❑ LOCAL AGENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' UTILITY
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
C{YLLISION O8 - 1-- 2024 2145 17 ❑.= S 8 W IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 375
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
UNIT 01 VEHICLE
MOTPI PEDAL-ORCYCLE ElDESA✓NHORESHOLD MET PHONE 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY Sr ZIP z
NEW ADDRESS
7❑ ODL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES No YES No
8 DRIVER'S. STATE SEX.U D.Q.B. 1 32
❑ :LICENSE# MMDDYY -=
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9❑ Pi AT 14 CGV1493 STATE WA VIN# 2HGFE1 F70PH319797
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. YRLR. 5 5 33
12❑ vIN#' VIN#
FROM r0
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ $ 34
13 2023 HOND CIVIC SD DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI V INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# eq�T9TOP
VE— 1 o BOTTO
CHARGE 1 5 36
LECALLv YFS❑NO❑ CITATION# M
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN ✓ :. PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ PROPSOWNER ❑ YES 1/ No D:2069453175
16 a
LAST NAME RAMIREZ FIRST NAME ALEXUS MIDDLE
INITIAL
17❑ NEW STREETR 7' 12410 SE 168TH ST CITY RENTON ST WA ZIP 98058 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑NOR INTERLOCK YEs❑NOF YES❑NO❑
19 F] DRIVE # STATE SEX F MMD D.O.B.B. 02 _ 20 _ 2003 39
ON DUTY❑ STATUS 3 AIRBAG RESTR EJECT H U NEST CLASINJURS INJURED
6 [NATURE OF INJURED FEET,i LEGS,STOMACH ES 40
❑21❑ LICENSE TATE IN# 41
V `1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 ] DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 e
='ROURKE
(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26 13007 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF16909
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9468
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'
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.
SHANNON OROURKE 09-10-24 11:54 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 9/21/2024 5:44:01 AM
BADGE OR ID# 13007 ORI# WA0171300 TIME POLICE DISPATCHED 12:45 PM TIME POLICE ARRIVED:1:00 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EF16909 CASE# 24-9468 OF COLLISION
08/30/24 21:45
OF CbLLI510N
NARRATIVE
Case #24-9468
On 09/09/2024 1 responded to a Physical Assault Report that occurred at Chic Fil A, located at 375
Rainier Ave S, in the city of Renton, King County, WA. The victim reported the crime to me at City
Hall (1055 S Grady Way, Renton, King County, WA).
Upon contacting the victim, Alexus Ramirez (DOB02/20/2003), she reported to me that while she was
working at Chic Fil A on 08/30/2024 at approximately 2146, the drive through lane became busy.
While taking orders and serving customers, a vehicle (LIC CGB1493) that was in line became
frustrated with waiting. The drive through has two lanes that run parallel to each other, and the driver
attempted to abruptly cut into the other lane. The driver then asked Alexus if she could fit into the
other lane, and Alexus directed the driver to reverse to avoid hitting a large stand directly beside
Alexus. Instead of following these directions, the driver hit the gas and aggressively pulled forward,
where they collided with the stand hard enough that it hit Alexus in the stomach and legs.
Additionally, the driver ran over Alexus' feet.
Alexus communicated to the driver that they had hit her. Alexus stated that the driver replied with
something to the effect of, "it's ok because the car isn't damaged".
Alexus reported it to her supervisor and called her mom- she was in pain from her feet being ran over,
but was also seriously concerned because she is pregnant. Her mother arrived and brought her to the
emergency room where she received stitches and medical care.
Alexus described the driver as a female wearing a black Hijab. There was another female in the
passenger side as well, also wearing a black hijab. They were seen in a silver Honda Civic, LIC
CGB1493. Alexus does want to press charges.
Alexus completed a Renton Police Department written statement, as well as a Medical Release
Form. I provided Alexus a community request from Axon via text for her to upload the video
surveillance she had of the accident.
This ends my report and there is no further suspect information currently.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by S. O'Rourke on 09/09/2024 at 1400 hours in the city of Renton, King County,
Washington.
PAGE 3 OF 4
REPORT NO. EF16909 CASE# ' 24-9468 DATE AND TIME 08/30/24 21:45
OF COLLISION
Diagra1, not to scale
PAGE 4 OF 4