HomeMy WebLinkAbout24-12323 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-12323 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#
COLLISION'. 11 - 1-- 2024 0059 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AV S BLOCK NO. e✓ 13100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ❑ FEET e S ❑ w S 132 ND ST
❑
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252603644 30
6 LAST NAME ZELEDON ROJAS FIRST NAME JOE MIDDLE C 1 1 2 31
INITIAL
STREET ❑1 11854 42ND AVE S CITY TUKWILA ST WA ZIP 981682523 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LICIENSE# STATE WA SEXI M M -O B 10 - 13 - 1983 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E C ASSS 1 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# CJE3216 sTAr WAu N# 1 FAHP3K20CL251026
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12❑ VIN#' VIN#
FROM
34
13 VEH.YEARN MAKE FORD MODEL FOGS STYLE SO VEHICLETOWED0NOOffBLIN WAWkkRS YOES❑ENO
DAMAGE IILLJJII tSA1Vi�6
REGISTERED OWNER INFO CODY GREEN 3792 MT BAKER HWY EVERSON WA 98247 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY#
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,'" 6
UNIT U2 MOTORVEHIC
❑ CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # 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❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ 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
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12651 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF41408
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12323
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'
Unit 1 traveling south along 13100 block of Rainier Av S at intersection of S 132nd St. Unit 1 driving
in heavy fog and veered into center raised concrete median, causing reportable disabling front end
and driver side damage. No injuries. Unit 1 driver estabished under prepoderance of evidence.
However, while Unit 1 driver was suspected to be DUI, no PC could be established as there were no
witnesses, no vehicle in motion, and no other definitive proof that Unit 1 driver had actually been
driving. Heavy fog at the time of collision may have also contributed to Unit 1's collision. Unit 1
impounded from scene without incident. No other vehicles nor property were damaged.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 11-29-24 02:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 121112024 7:00:08 PM
BADGE OR ID# ! 12651 ORI#' WA0171300 TIME POLICE DISPATCHED 4:08 AM TIME POLICE ARRIVED 1:11 AM
PART I PAGE IT]OF 3�
REPORT NO. EF41408 CASE# ' 24-12323 DATE AND TIME 11/29/24 00:59
OF COLLISION
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