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HomeMy WebLinkAbout24-5686 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 SASE 24-5686 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 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 1715 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ KIRKLAND AV NE BLOCK M1200 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �,❑ FEET e S ❑ W e NE 12TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2532946657 0 11 30 6� LAST NAME HOLLE FIRSTNAME MIKAYLA MIDDLE W 1 1 2 31 INITIAL STREET ❑ 13732 12TH AVE S W#64 CITY BURIEN ST WA 2jp, 981661146 z NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 ❑ iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z YEs No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10 2❑ P1 AT 14 D543728 STATE WA VIN# 1 FTRF14516N622346 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 2 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN I TOWED BY GOVT.VEHICLE 5 1 34 13 4 2006 FORD F150 TR DAMAGE YES fn TO YES[:] H REGISTERED OWNER INFO SVCALLYWASTE lWNHOWARDST SPOKANEWA99201 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO <1�3 4 14 MUTUAL INS OF ENUMCLAW CPP0028235 LI EFFECTISUR N# TOPVEHICLE CHARGE 36 LE ALLv YEs No clTAnoN# 4A0313572 OP MOT VEH W/OUT INSURANCE orrom 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE �NiT VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:4256105880 16 a LAST NAME GARCIA CASTILLO FIRST NAME ABEL MIDDLE N INITIAL 17❑ STREET ❑', 2027 HARRINGTON CIR NE CITY RENTON ST WA ZIP 980562320 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DRIVER'S STATE WA SEX M D.O.B. 09 _ 07 1964 39 LICENSE# MMDDYY WELMET INJURY 7 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS SHOULDER PAIN LEFT ❑ 21❑ LICENSE BOH3866 TATe WA vIN1l JT2BF12KXT0172318 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 1996 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDev GOV HI �44 24❑ DAMAGE YES�/ NO BANKERS YES NO REGISTERED OWNER INFO ABEL GARCIA CASTILLO 2027 HARRINGTON CIR NE RENTON WA 98056 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU PORGY#E CO NATL GENERAL 2021015945IN STOP 5 Le L..LLY YES❑ N,J� CITATION# CHARGE i o BOTTOM LEGA 6 25= OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# TNCY26HANSEN HSU 12651 0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE82905 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5686 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MUJO TORRES FIDELINO (LAST FIRST, ADDRESS&PHONE# D O.B. ' 3340 SE 5TH ST RENTON WA 980580000 SEX M MMDDYyry 06 - 10 - 1962 PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ ❑ 2 POS. : 3 2 4 1 USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D 0.B SEX' MMDYYYY PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 traveling east on NE 12th St approaching the intersection at Kirkland Av NE. Unit 2 traveling north on Kirkland Av NE approaching intersection at NE 12th St. Four way intersection. Unit 1 driver admits on scene that they rolled through the stop sign at the intersection and did not come to a full stop. Unit 1 strikes Unit 2 causing reportable non disabling front end damage to Unit 1 and reportable disabling front driver side damage to Unit 2. Unit 2 driver complaint of left shoulder pain. Aid declined at scene. Unit 1 driver cited for no valid vehicle insurance. Based on interview of involved parties. Unit 1 driver's actions were the proximate cause of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 05-29-24 06:56 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE E.EDMUNDS 12576 6/3/2024 2:10:11 AM BADGE OR ID# 12651 OR]# ': WA0171300 TIME POLICE DISPATCHED 5:17 PM TIME POLICE ARRIVED 5:26 PM PART I PAGE IT]OF 3� REPORT NO. EE82905 CASE# ' 24-5686 DATE AND TIME 05/29/24 17:15 OF COLLISION o 3, -m,,a aka ZUP k 1, PAGE 3 OF 3