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HomeMy WebLinkAbout24-5513 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-5513 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# ❑ cowsloN 05 - 1-- 2024 1857 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 10TH ST BLOCK NO. e✓ Y800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e INDEX AVE NE 0 3 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO F,/ I D:2532870718 0 11 30 6� LAST NAME JIGGETTS FIRSTNAME JAYNI MIDDLE A 1 1 2 31 INITIAL STREET ZI 1124 HARRINGTON AVE NE 301 CITY RENTON ST WA ZIP 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8 LRIIVER # STATE SEX'F MI 07 1- 31 - 2007 2 32 ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USEET IINIJAU RY 1 NATURE OF INJURIES z❑ 3 10� Pi aT�S� CBV9976 sTATe WA VIN# 1G1BL8371N2136111 5 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM To TRLR. TRLR 1 7 33 12 1VIN#j VIN#' <:...... FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 2 1992 CHEV CAPRIC SW DAMAGE YES NO YES❑ No✓ REGISTERED OWNER INFO ROMEROBOISSEIRE 1124 HARRINGTON AVE NE 301 RENTON WA 98056 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# STOP VEHICLE CHARGE 1 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066939385 16 a LAST NAME MUZZAFFARY FIRST NAME MARZIA MIDDLE INITIAL 17❑ STREET ❑', 3126 GARDEN AVE N CITY RENTON ST WA ZIP 98056 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCK YES❑NO� INTERLOCK YEs❑NOF YES❑NOF,/ 19 DRIVER'S STATE WA SEX F D.C.B. 03 _ 30 _ 1995 0 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE ATS0675 TATe WA VIN# JTDKN3DUOA0140303 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GoI VEH YEAR 2010 MAKE 7'Dy7- MODEL pRIUS STYLE 4H —FEHICLE TOWED NOO✓ BLIN TOWED BY v HYES NO 1/ 44 24❑ fj REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAGED AREA 2 4 LIABILITY INSURANCE INSU&PORGY#E CO STATE FARM 426-4310-F18-47EIN 1GQ'E""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE80527 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5513 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) BOISSIERE ROMERO (LAST FIRST, ADDRESS&PHONE# D O.B. ' 1124 HARRINGTON AVE NE 301 RENTON WA 98056 2065798942 SEX M MMDDYyry 06 - 24 - 1980 PASSENGER Z WITNESS ,UNIT# j 1 SEATPOS. 3 AIRBAG 1 RESTR, q EJECT ? 1 HELMET INJURY NATURE OF INJURIES USE CLASS i1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX MMDDYYYV PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS 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' Unit 2 westbound on NE 10th St, Unit 1 turning from southbound Index Ave NE onto westbound NE 10th St. Unit 1 pulled onto NE 10th St after stopping for a stop sign, into path of unit 2 which had no traffic control. Unit 2 unable to avoid unit 1, and passenger side of unit 2 impacted left front corner of unit 1. Unit 2 was driven by Jayni Jiggetts, who was 16 years old and unlicensed. Unit 2 registered owner Romero Boissiere was front seat passenger in Unit 1, and the only other occupant. Boissiere told me that he was teaching his kid Jiggetts to drive. Boissiere appeared intoxicated, and admitted to drinking prior. Boissiere was unable to show proof of insurance, and could not tell me who his insurance company was. Jiggetts had no license record, but her identity was confirmed by her mother Heather Gallagher, who came to the scene to drive Unit 1 away. Boissiere issued NOI for Allowing Unauthorized Minor to Drive, No Liability Insurance or Other Financial Responsibility. Jiggetts issued NOI for Failing to Yield Right of Way, and for No Valid Operator's License. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 05-24-24 09:20 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 5/26/2024 9:46:06 AM BADGE OR ID# 5738 ORI#' WA0171300 TIME POLICE DISPATCHED! 6:59 PM TIME POLICE ARRIVED f 7:03 PM PART Ei PAGE IT]OF REPORT NO. EE80527 CASE# ' 24-5513 DATE AND TIME 05/24/24 18:57 OF COLLISION �P ;.. Unit 1 w s � a .., ,<.. Unit IY t I PAGE 3 OF 3