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HomeMy WebLinkAbout24-11383 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-11383 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 28 TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ GawsloN 11 - 1-- 2024 0709 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S CARR RD BLOCK NO. e✓ 600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 300 00 FMILES EET e S B W e SMITHERS AVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2067976635 30 LAST NAME BELLO RODR/GUEZ FIRST NAME BRAYAN MIDDLE q 6 INITIAL 0 1 31 STREET ❑✓1 17844 120TH AVE SE CITY RENTON ST WA 2jp, 98058 z NEW ADDRESS 7❑ CDL I 1/ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO NTERLOCK YES NO YES R No $ LICIENSE#VERS STATE SEX'M MDMDD 11 - 16 - 1999 32 9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� A7816574 sTArI WAvIN# 2HGEJ8643TH528130 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro TRLR. TRLR 2 6 33 12❑ VIN#' VIN#' FROM 34 13� VEH.YEAR 1996 MAKE HOND MODEL CIVIC STYLE 4D DAMAGE TOWED NOO pLSABLIN TQ yED.BLRS YES[:]DAMAGE IILLJJII ttSSAA1IVV/i��66 REGISTERED OWNER INFO BRAYANBELLO RODRIGUEZ 178"120THAVESERENTONWA98058 D:2067976635 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO V34 IN EFFECT &POLICY#VEHICLE CHARGE536 LECALLv YES❑NO CITATION# 1 15❑ STAIN."' UNIT 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO YES [:]I DYES NO OLD MET PHONE 16❑ LAST NAME FIRST NAME MIDDLE INITIAL STREET 17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIRIVEWSTICENS # STATE SEX MMDDYY 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ LICENSE TArE vIN# 41 PLATE# 42 22❑ PR TRAILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 24❑ 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 IGQ'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. EF32557 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11383 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 FIRST 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 1 traveling downhill from NE to SW on S Carr Rd, in number 2 lane. Vehicle rode up over north sidewalk and into jersey barricade. Unit 1 struck barricade nose first, rotated clockwise and impacted rear driver's side quarter panel, then slid to end up facing barricade. Driver Bello Rodriguez told me that he just bought car (10/10/2024 date of sale), and that the brakes failed as he tried to slow to negotiate the downhill roadway. No injury, no damage to other property. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 11-02-24 08:14 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 1 111612024 4:00:47 AM BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED 7:13 AM TIME POLICE ARRIVED f 7:21 AM PART I PAGE IT]OF 3� REPORT NO. EF32557 CASE# ' 24-11383 DATE AND TIME 11/02/24 07:09 OF COLLISION tx 3 x r 4 t t t 1 Y y'YyE hi, ,ii � Y V t Al 10 el t F fit uiPrtil„txRY`xs3il"t > Y � � S. f; PAGE 3 OF 3