HomeMy WebLinkAbout24-4675 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-4675 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 04 - 1-- 2024 2144 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257362718 0 11
30
6❑ LAST NAME MILTON FIRSTNAME CHRISTOPHER MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 2617 271ST AVE SE CITY ISSAQUAH ST WA 2jp, 98029 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 07 1— 19 — 1990 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATFBit 98YY311 sTArI CA urN#' 1GYS4EKL7PR185858
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR N MAKE CADI MODEL ESCALA STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
DAMAGE YES NO ✓ YES[:] NO✓
13❑ REGISTERED OWNER INFO CHRISTOPHERMILTON2617271STAVESEISSAQUAHWA98029 D:4257362718 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO STATE FARM 4219938C2147A 3 4
IN EFFECT &POLICY# 9TOP
15
vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
❑ STAIN,DIING 8 7 6
UNIT 02 VEHIMOTCCLE CYCLE ❑ PEDESTRIAN ❑ OWNFR PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME GUTIERREZ FIRST NAME TERESA MIDDLE R
INITIAL
17❑ STREET ❑', 2508 SE 16TH ST CITY' RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 LICENSE# STATE WA SEX F M D.C.B. 04 19 _ 1986 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CFJ3595 TAre WA VIN# 1FMFU18L03LB16462
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2003 MAKE FORD MODEL EXPEDITI STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO MICHAEL HANNON 20913175TH STREET CTE ORTINGWA98360 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 2020754085IN 1 9TOP 5
VEHICLE YES❑ N,.I—J I CITATION# CHARGE i o BOTTOM
LEGALLY 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
N.ODALOV/C 11628 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE74265
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4675
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GUTIERREZ JORGE
(LAST FIRST,
ADDRESS&PHONE#
RENTON SEX M MMDDYYYY 11 - 11 - 2010
PASSENGER I�I WITNESS 'UNIT# j 2 P� 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET NJURY NAruRE of INJURIEs
L`!1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) GUTIERREZ ROBERT
ADDRESS&PHONE# D O B
RENTON SEX M MMaovvvv 03 _ 14 _ 2017
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
U1 and U2 were traveling eastbound approaching Monroe Ave NE on NE 4th St. U1 was in lane 1
and U2 was in lane 2. U1 stated he had his right blinker on indicating he intended to merge into lane
2 and stated U1 increased their speed. Due to the increase in speed, he stated he collided with U2.
U2 stated that the vehicle was traveling straight when U1 crossed in front of U2 to enter the plot of
Chevron, 3209 NE 4th St. Chevron is on the south side of the roadway. I believe U1 was the primary
cause of the collision as U1 did not yield to U2 and merged into lane 2 to enter the plot of Chevron.
No airbags were deployed, and no one reported any injuries. Both vehicles were not drivable. No
police requested tows were made as both vehicles ended up in the plot of Chevron. Both drivers were
provided with the case number. I took photos of the vehicles which were later uploaded to
evidence.com. During this incident I was equipped with body-worn camera which records both audio
and video. Portions of the incident were recorded. This report is merely a summary of the incident
and is not intended to be an exact transcription of the entire investigation or what may have been
captured with the recording system.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
N.ODALOVIC 05-01-24 02:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 51512024 6:39:01 PM
BADGE OR ID# 111628 OR]#' WA0171300 TIME POLICE DISPATCHED 9:44 PM TIME POLICE ARRIVED',9:44 PM
PART I PAGE IT]OF 3�
REPORT NO. EE74265 CASE# 24-4675 DATE AND TIME 04/30/24 21:44
OF COLLISION
Ul BLKVEH NOT TO SCALE
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w PAGE 3 OF 3
