Loading...
HomeMy WebLinkAbout25-750 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 ❑ ❑ RESULTED ❑ CASE# zsaso 2 INTERSTATE CITY STREET FIRE 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3 HIT&RUN CODING' COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS . OZ STRUCK RESERVATION 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 01 - 23 - 2025 2139 17 ❑.❑ S IN 1070 3 4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SUNSET BLVD N BLOCK NO. 1❑ e✓ MILEPOST 4a DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 2000 FEET e S B W e N 3RD ST 0 4 29 UNIT MOTOR Z CYCLE El DAMA NO THRESHOLD MET PHONE 0 1 30 6 LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY RENTON Sr ZIP Z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8 DRIVERS. STATE SEX.U D.O.B. 1 1 2 32 ❑ :LICENSE# MMDDYY -= 9 ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT 1 H U SE AIRBAG 9 CLJU ASSY 0 [NATURE OF UNKNOWNNJURIEs z❑ 3 LICENSE CDV0008 STATE WA VIN# 1HGCB9854PA004943 10 9❑ pI ATF� 11 FTRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM ro TRLR. YRLR. 3 5 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 3 1993 HOND ACCOR SD DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO MARLON KILLION 1708 JONES DR SE RENTON WA 98055 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 r1 LIABILIT INSURANCE❑ INSURANCE CO NA NA 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLv YFS❑NO CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062317176 16 a LAST NAME ALVARRACIN MUEVECELA FIRST NAME JOHANA MIDDLE P INITIAL 17 STREET❑ NEW ADOREsS❑' 16482 109TH AVE SE CITY RENTON ST WA ZIP 98055 37 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 # ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 6 NECK PAIN AND HEAD PAIN ❑[-�A—TUREOF INJURIES 40 LICENSE I ❑21❑ PLA E# CNS0282 TATE WA VIN# 41 19XF62F86EE271169 4 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. G HI 44 VEH YEAR 2014 MAKE HOND MODEL CIVIC STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov YES NO 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO NA NA STOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 KEVIN PETERSON 12808 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF59835 COLLISION REPORT III III III III III 111 1591972 CASE# 25-750 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,FIRS 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. KEVIN PETERSON 01-24-25 01:12 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE X LANE 10008 112712025 9:46:09 AM BADGE OR ID# ( 1Y808 OR]# WA0171300 TIME POLICE DISPATCHED! 9:89 PM TIME POLICE ARRIVED 10:07 PM PART B PAGE IT]OF 4� REPORT NO. EF59835 CASE# 25-750 OF LNa 01/23/25 21:39 F coy�isI©�ON u NARRATIVE Unit 2 told me that she was unsure of the road she was on, but it was buying the smoke shop and 7Eleven. She continued to tell me that she was hit at the stop sign. She said not a stop light, but sign and Unit 1 did not stop at the stop sign. The driver complained of neck pain and head pain. She said the front of the vehicle hit her driver side door. The driver of Unit 2 requested to be seen by medics on scene, Fire and medic arrived on scene to evaluate the driver. Medical then transferred the driver to the hospital due to neck pain. Unit 2 stated that her insurance had just expired, and she had not renewed it yet. Per call notes the vehicle was green sedan with white strips and last seen going East on N Brooks ST. I located the accident scene on Sunset Blvd N just under 405 off ramp. The damage to the driver side door of Unit 2 and the given statement from them is consistent with the accident scene. The turn around just under 405 is where the damage of the vehicle was, and a green front bumper and license plate were left at the scene. I checked the RO address, and the vehicle was not on location, but the vehicle color and sedan future fit the suspect vehicle. Driver did not state weather or not she could ID the driver of the other vehicle. I took pictures of both Unit 2's vehicle and the accident scene that I was able to find which was uploaded to evidence. Unit 2 was given the case number as reference. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 01/23/2025, 2346 hours at Renton, WA PAGE 3 OF 4 REPORT NO. EF59835 CASE# 25-750 DATE AND TIME 01/23/25 21:39 OF COLLISION '�=r eR. r a q I lY "r t 3 } PAGE 4 OF 4