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HomeMy WebLinkAbout24-5051 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-5051 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑ COLLISION: 05 — 1—— 2024 1310 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 2ND ST BLOCK e✓ 200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 6❑ 50 00 FEET e S ❑ W V LAKEAVES 2 0 29 UNIT MOTOR VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30 6❑ LAST NAME CRUZ, FIRSTNAME BENJAMIN MIDDLE E 1 1 2 31 INITIAL STREET ❑ 2602 WESTRIDGE AVE W,APT X10 CITY TACOMA ST WA 2jp, 98466 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ CORNER # STATE WA SEX'M MID LOB 10 1— 22 — 1991 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10[9 ICE P1ATNE14 D30914C STATE WA VIN# 1FTEW1EG7HFA47311 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34 13 1 2017 FORD 150 PK DAMAGE YES NO �LIkRS TOWING ves❑ No REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO USAA 030486893 030486893 3 4 IN EFFECT &POLICY# 9TOP LEGA LE CHARGE 5 36 LEIF" Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063560414 16 a LAST NAME TAX SIC FIRST NAME GABRIEL MIDDLE IN INITIAL 17❑ STREET ❑', 3251 S 176TH ST,APT 222 CITY' SEATAC ST WA ZIP 98188 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCK YES❑NOR INTERLOCK v�Esl❑NOF YEs❑NO❑ 19 DRIVER'S STATE WA SEX M D.C.B. 07 10 _ 2003 39 LICENSE# MMDDYY WELMET INJURY 7 NATURE OF INJURIES 40 20❑ ON DUTY[:I] STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS RIGHT LEG ❑ 21❑ LICENSE I CKH3623 TATe WA VIN# 1FAFP4040XF109474 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. roweD By Gov HI 44 VEH YEAR 1999 MAKE FORD MODEL MUSTAN STYLE P2 DAMAGE TOWED✓ NOO BLIN GENE MEYERS TOWING YES NO�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE DAGED AREA 4 LIABILITY INSURANCE❑ &POINSULICY#E CO N/A N/AIN 9TOP VEHICLE ❑ C[:] CITATION# CHARGE io BOTTOM LEGALLY YES N 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 SULIASI TAMAIVENA 12788 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE77093 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5051 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' On 05/12/2024, at approximately 1313 hours, I was dispatched to an accident at S 2ND ST/LAKE AVE S in the City of Renton, County of King, State of Washington. I spoke with Unit#1, who advised that he was in lane #2 (lane #1 being near the south curb) and was attempting to cross into lane #1 but was unaware that Unit#2 was already in lane #1. In doing so, his vehicle hit the side of Unit#2, causing Unit#2's vehicle to go onto the curb. Unit#1 had his front left bumper damaged and his driver-side tires flat. The vehicle could not drive, and it was towed at his request by Bankers Towing Company. He was uninjured. I spoke with Unit#2, who advised that he was in lane #1 driving straight when he was hit by Unit#1 on the side. He stated that Unit#1 crossed over from lane #3 when he was hit. I observed that Unit#2 had damaged the front bumper and right fender. Both right-side tires were flat, and Gene Meyers Towing towed his vehicle at his request. He said that his leg was hurt but that he did not want aid, so he said he would see a local hospital later today. Both parties exchanged information, and I also provided them with my business card and case number. Photos were taken and uploaded to evidence. There are no signs of foul play from either party. 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. Tamaivena #12788 on 05/12/2024 @ 1835 hours in Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SULIASI TAMA/VENA 05-12-24 06:36 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 1 511512024 4:52:46 AM BADGE OR ID# 1Y788 OR]# j WA0171300 TIME POLICE DISPATCHED', 1:11 PM TIME POLICE ARRIVED f 1:17 PM PART I PAGE IT]OF REPORT NO. EE77093 CASE# ' 24-5051 DATE AND TIME 05/12/24 13:10 OF COLLISION x J` 4 r 3 PAGE 3 OF 3