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HomeMy WebLinkAbout24-11795 ITFF' " ll� . 471 27POLCERA c III II COLLISION REP FIT 1591971 CASE 24-11795 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4900 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# ❑ GowsloN 11 - 1-- 2024 1948 17 ❑.❑ S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 116TH AVE SE BLOCK NO. e✓ 17200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e OF, 1 29 MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE NIT 01 VEHICLE ❑ CYCLE. ❑ YES NO F D:2065381047 0 9 30 6 LAST NAME ALSTON FIRSTNAME JANEIL MIDDLE E 1 1 2 31 INITIAL STREET ❑, 1253 S JACKSON ST 309 CITY SEATTLE ST WA ZIP 98144 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID LOB 11 - 28 - 1995 1 2 32 9 ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ Pi aT�S� CHR0774 sTArI WAVrN# 3CZRU6H70HM716920 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. YRLR. 1 5 33 12 3 5 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE g 9 34 13 2 2017 HOND HR-V HB DAMAGE YES NO MEYERS YES[:] NO✓ REGISTERED OWNER INFO EMANI ALEXANDER ROYSTER 1603WJAMES LNAPT 2.104 KENT WA 98032 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 NSURANCE CO 4 14 LIABILITY INSURANCE❑ PACIFIC STAR 5551435 IN EFFECT &POLICV# TOPve FFE CHARGE <1�3 OTTOM 5 36 LEGALLY YES No clTAnoN# 4A0852969,4A0852969, DRIVE DANGEROUSLY DISTRACTED, 15❑ STANDING 6 MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2067476984 VEHICLE CYCLE OWNER 16 a LAST NAME IMANISHI SMULLING FIRST NAME ISABELLA MIDDLE IR INITIAL 17 STREET I❑ S❑' 4914 55TH AVE S CITY SEATTLE ST WA ZIP 98118 4❑ 37 NEW ADOREs 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/ 19[ DRIVER'S STATE WA ]SEX IF D.O.B. 12 _ 30 _ 1997 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES 40 USE CLASS BACK PAIN LICENSE I ❑21❑ PLA E# CKP9678 TArE WA VIN# 41 SHHFK8G70KU202698 1 42 22❑ PLATE# STATE PLATE# STATE T 23❑ 43 IN# IN RLR #.UIN#. ' TOWED BY Gov HI 44 VEH YEAR 2019 MAKE HOND MODEL CIVIC STYLE HB DAMAGE TOWED NOO✓ BLIN YES NO 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGE$AREA 2 3 �d LIABILITY INSURANCE INSU&PORGY#E CO GEIC04428842274IN 1 9TOP VEHICLE CITATION# CHARGE i o BOTTOM LEGALLY YES NC[:] 25❑ s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 STEVEN FAJARILLO 12847 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38794 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11795 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 PM 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. STEVEN FAJARILLO 11-14-24 12:26 AM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1112312024 9:53:14 AM BADGE OR ID# 12847 ORI# WA0171300 TIME POLICE DISPATCHED! 7:50 PM TIME POLICE ARRIVED',7:51 PM PART B PAGE IT]OF 4� AND REPORT NO. EF38794 CASE# 24-11795 OFCOLLISION 11/13/24 19:48 OF COLLISION�isi©�u NARRATIVE 24-11795 This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. On 11-13-2024 1 was working as a police officer in the city of Renton. At approximately 1950 hours I was dispatched to the report of a vehicle collision at 17240 116th Ave SE, City of Renton, County of King, WA. This incident was captured on my department issued Axon body camera. According to the notes in the call, there was a motor vehicle collision with injury in front of location. Renton Fire Authority was already on scene and cleared all involved medically. The driver of Unit 2 complained of back pain. I spoke with the driver of Unit 1. He said he was travelling south on 116th Ave SE and dropped his cell phone. He leaned over to pick it up and did not see Unit 2 had stopped. The front bumper of Unit 1 collided with Unit 2. 1 spoke with the driver of Unit 2. She was stopped in the south lane of travel waiting to take a left hand turn into her driveway when Unit 1 collided with her. Officer Ediger photographed the scene and the vehicles. I provided the driver of Unit 2 with a case number. The driver of Unit 1 left the scene before I was able to give him a case number. Unit 1 was towed by Gene Meyers. Unit 2 was driven into the nearby driveway of the registered owner. I completed a notice of infraction for the driver of Unit 1 for operating a motor vehicle without proof of valid insurance, no valid operator license with identification, and driving dangerously distracted. The driver of Unit 1 dropped his cell phone and he attempted to pick it up off the floorboard. The driver of Unit 1 did not see Unit 2 had stopped and was the proximate cause of the collision. There is no further information available at this time. 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. Fajarillo #12847 on 11/14/2024 @ 0009 hours in Renton WA. PAGE 3 OF 4 REPORT NO. EF38794 CASE#', 24-11795 DATE AND TIME 11/13/2419:48 OF COLLISION CD (D (A (D (D "o 0 CD PAGE 4 OF 4 i If 1 Not to Scale „ x Point of impact �� r e Unit 2 k k�3 ti