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HomeMy WebLinkAbout24-10640 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c COLLISION REP FIT 1591971 SASE 24-10640 2 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❑ TRIBAL 02 TOTAL#OF 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 - 11 - 2024 1713 17 =. S H W H OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ PARKAVN BLOCK e✓ 400 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e N 4TH ST OF,1 29 MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE NIT 01 VEHICLE ❑ CYCLE. ❑ YES NO F D:2064124848 0 1 30 LAST NAME RODRICoUEZANDRADE FIRSTNAME NURIA MIDDLE' A 6 INITIAL 1 2 31 STREET ❑ 526 PELLYAVE N CITY RENTON ST WA Zlp' 980575425 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/ 8 LICENSE DRIVER # STATE I WA SEX'F MM ovY 02 - 14 - 2002 1 2 32 9❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10❑ Pi aT�S� CHD6742 sTATe WAurN# 1HGCY1F39PA008133 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 3 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GES[VEHICLE 1 5 34 13 4 2023 HOND ACCOR SD DAMAGE YES NO �LII� RS vEs❑ No✓ REGISTEREDOWNERINFO ANDRADERODRIGUEZ526PELLY AVE N RENTON WA 98057 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE NSURANCE CO GEICO 4566619377 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE36 LEGALLv Yes❑NO CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ : OWNFR ❑ YES 1/ NO D:2532520238 LAST NAME ROMERO ALMENDARES FIRST NAME JENDER MIDDLE M INITIAL 17❑ STREET ❑', 412 195TH AVE E APT 16 CITY LAKE TAPPS ST WA ZIP 983919360 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 LICENSE# STATE WA ]SEX IF MMDDW 02 _ 11 1998 El 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CGV7887 TATe WA VIN# KNDJP3A51G7323731 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2016 MAKE KIA MODEL SOUL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44 24❑ DAMAGE YES�/ NO BANKERS YES NO REGISTERED OWNER INFO LILIAN GUEVARA ECHEVERRIA 82416TH STNW PUYALLUP WA 98371 VEHICLE NO.2 SHADEd DAtYGED AREA 4� 4 LIABILITY INSURANCE &POINSURGY#E CO STATE FARM 447576162347EIN STOP 5 VE"Le ❑ ,J� CITATION# CHARGE toBOTTOM LEGALLY YES N`L J 25 ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 HANSEN HSU 12651 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. EF251 13 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10640 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) CORNEJO CERROS FATIMA Y (LAST FIRST, ADDRESS&PHONE# D O.B. 11369 SE 168TH ST RENTON WA 980555935 3857708993 SEX F MMDDYyvv 10 - OS - 1995 PASSENGER WITNESS❑ UNIT# 2 POS 'I 3 AIRBAG 6 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) THORBJORNSEN THOR M ADDRESS&PHONE# D O B 12223 SE 306TH CT AUBURN WA 98092 2533261778 SEX M MM�Duvvv 01 _ 29 _ 1967 PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES []WITNESS POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 traveling west on N 4th St at intersection of Park Av N. Unit 2 traveling south on Park Av N at intersection of N 4th St. Unit 1 ran red light at intersection and was the proximate cause of collision with Unit 2, causing reportable disabling front and passenger side damage to Unit 1 and reportable disabling front end damage to unit 2. No injuries. Both vehicles impounded from scene. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 10-11-24 06:12 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 10/16/2024 4:27:20 PM BADGE OR ID# ! 12651 ORI# WA0171300 TIME POLICE DISPATCHED 5:16 PM TIME POLICE ARRIVED',5:20 PM PART B PAGE IT]OF 3� REPORT NO. EF25113 CASE# 24-10640 DATE AND TIME 10/11/2417:13 OF COLLISION 10 01 ED d lF� r r s 5 � 3 1 ti 4 4 r ' 'rye ti PAGE 3 OF 3