HomeMy WebLinkAbout24-5394 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-5394 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
i TRIBAL 1 02 STRUCK UT/LITYPOLE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 05 — 21 — 2024 1408 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. e✓ 1900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4259199160 30
6 LAST NAME ZABALA FIRSTNAME AL STEVEN MIDDLE G 1 1 2 31
INITIAL
STREET ❑, 1305 S PUGET DR#B31 CITY RENTON ST WA 2jp, 98055 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� PI ATFBit BZF4418 sTATI WAvIN#' 1J4GL48KX3W734577
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 3 33
12❑ vIN#' VIN#'
RomM TO
34
13❑ VEH.YEAR ZOOS MAKE JEEP MODEL LIBERT STYLE SV VEHICLE TOWED 0 TOO ffBLIN WAW7.BLRS TOW YOES❑ENO
DAMAGE ILJI tSA1Vi�c
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑ ❑
14 LIABILITY INSURANCE❑ INSURANCE CO NONE SHADE IN DAMAGED AREA 35
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LEGALLY res�No D CITATION# 4g0375524 CHARGE OP MOT VEH W/OUT INSURANCE )o eorrom
STANDING 8 7 6
UNIT VEHIOCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERMOTR PEDAL- RTY ❑ DYES NO ✓OLD MET PHONE
16❑
LAST NAME PUGET SOUND ENERGY FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l No❑
19 LLIICENS RIVERIS# STATE SEX U MMDDYY 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PIR I I TRAILER LATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ
VEHICLe ❑ ,.I— CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7,L
CER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
LI M RIDGEWAY 12500 WA0171300
A
26
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE79423
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5394
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.
W/LLIAM RIDGEWAY 05-21-24 03:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 512212024 1:16:25 PM
BADGE OR ID# 12500 OR]4f WA0171300 TIME POLICE DISPATCHED 2:08 PM TIME POLICE ARRIVED',2:11 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE79423 CASE# 24-5394 OF COLLISION05/21/24 14:08
NARRATIVE
At about 1408 hours on 05/21/2024, 1 was dispatched to an unknown injury accident that occurred at
about the 1900 block of westbound NE 3rd St. in the City of Renton, King County, Washington. The
accident involved a black Jeep Liberty into a utility pole. The male driver was observed walking
around the vehicle.
Upon arrival, I contacted the male driver, who identified himself as the registered owner: Al Steven G.
Zabala (DOB:06/06/1990 -verified by WADL photo). He was told he would be recorded. Unit 1 was a
black 2003 Jeep Liberty (BZF4418/WA). Unit 1 struck a PSE utility pole #X6002. Al Steven was told
he would be recorded. Al Steven said he had no injuries when asked. No air bags were deployed.
PSE was notified by Renton front counter to evaluate the pole. The pole did not appear damaged but
a bracket holding another metal pole to the wood base appeared loose. I observed the rear
passenger's side wheel of Unit 1 had sheared off the axel and significant damage along the
passenger's side of Unit 1. Photos were taken and uploaded.
I did not observe anything indicating Al Steven was under the influence of drugs or intoxicants. When
asked if Al Steven had been drinking, he answered no. There was no evidence inside the vehicle of
possible impairment from open view.
Bankers Tow arrived and conducted a private tow for Unit 1 to Al Steven's registered address.
Al Steven said he was traveling in lane #1 going eastbound on NE 3rd St., when he made a lane
change into the #2 lane. He said the steering wheel locked and he lost control of his vehicle, causing
it to spin out into the westbound lane and stop after it collided with the utility pole. The roadway was
wet, conditions were daylight and raining.
Al Steven was unable to provide proof of insurance. I issued Sector traffic infraction #4A0375524 for
operating a motor vehicle without insurance. He was told it would be mailed to him at his registered
address.
I provided him with a business card and case number.
This concludes my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by W. Ridgeway#12500 on 05/21/2024 at 1549 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. EE79423 CASE# ' 24-5394 DATE AND TIME 05/21/24 14:08
OF COLLISION
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PAGE 4 OF 4
