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HomeMy WebLinkAbout24-4739 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c COLLISION REP FIT 1591971 CASE 24-4739 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28 UNITS RESERVATION I I STRUCK z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CtLLISION' 05 - 1-- 2024 1644 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ DUVALL AVE NE BLOCK NO. e✓ --- ----� 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 300 00 FEET MILES e S B W e NE 10TH ST 0 6 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067123756 0 6 30 6� LAST NAME POLICARPO FIRSTNAME SANTANA MIDDLE L 1 2 31 INITIAL STREET ❑✓ 3612 NE 4TH ST UNIT 18 CITy RENTON ST WA 2jp, 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ PI ATE CLF5486 sTArI WAvIN#' 3FADP4FJ2BM167227 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR. 1 5 33 12 3 5 VIN#j VIN# FROM TO ❑ VEH.YEAR 2011 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34 13 4 FORD FIESTA HB DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO MARLENIRUIZ-MORGA 17033116THAVE SE RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT I POLICY# 9TOP VEIF" CHARGE 5 36 LEGALLv res❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2065297450 16 a LAST NAME FORTIN FIRST NAME BRANDON MIDDLE A INITIAL 17 STREET I❑ S❑' 4233 NE SUNSET BLVD CITY' RENTON ST WA ZIP 98059 4❑ 37 NEW ADDRES 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19[—] DRIVER'S STATE WA SEX M D.O.B. 11 11 1982 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑21❑ PLATE# 41 C35000L TArE WA VIN# 1FTYR44UO5PA05629 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. N#. 43 RLR 'I VEH YEAR 2005 MAKE FORD MODEL RANGER STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO PEDRO VAZQUEZ ALCAZAR 16619126TH AVE SE RENTONWA98058 D:2065297450 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POINSURGY#E CO FARMERS 60677-23-05IN I STOP VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N 25 $ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 KEV/N PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE75201 COLLISION REPORT III III III III III 111 1591972 CASE# 24-4739 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' I was dispatched to a collision on 05/02/24 at 1648 hours at Duvall Ave NE and NE 10th St in city Renton, King County WA. Unit 1 CLF5486 Driver: Santana L. Policarpo (DOB 04/26/1996) Unit 2 C35000L Driver: Brandon A. Fortin (11/11/1982) Unit 2 was traveling in lane 1 South on Duvall Ave NE when he slowed for vehicles making a right- hand turn into the school parking lot. When he slowed down, he was then struck by Unit 1. Unit 2 was working for The Garage in Renton and was test driving the vehicle. Unit 1 was traveling South on Duvall Ave NE when he told me he was distracted by his phone and hit Unit 2. Unit 1 said he hit his breaks but did not have enough time to stop. I cited Policarpo for operating a motor vehicle without insurance, no valid operating license with ID and dangerously distracted driving. All 2drivers stated they had no injuries and did not need medical attention. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 05-03-24 12:48 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 51812024 10:47:40 AM BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED; 4:48 PM TIME POLICE ARRIVED:4:52 PM PART Ei PAGE IT]OF REPORT NO. EE75201 CASE# ' 24-4739 DATE AND TIME 05/02/24 16:44 OF COLLISION s Not to, sc, 1'u n F t, PAGE 3 OF 3