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HomeMy WebLinkAbout24-5849 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 SASE 24-5849 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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'. 06 - 1-- 2024 0643 17 ❑.= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S GRADY WAY BLOCK NO. e✓ 100 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e LAKEAVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2068928268 N:5099493903 0 81 30 6� LAST NAME RAMIREZ FIRSTNAME JOSE MIDDLE L 1 1 2 31 INITIAL STREET ❑, 1201 THOMAS LN S 2 CITY RENTON ST WA ZIP' 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 �/ I INTERLOCK YES[:]No NTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aTES� C79042L srATI WAurN# 1FTYR1YG1JKA26175 -- TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 3 7 33 12 0 0 VIN#j VIN# :: FROM TO VEH.YEAR 2018 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /[g GOVT.VEHICLE 9 9 34 13 FORD TRANSI CG DAMAGE YES NO � '` RS YES❑ No✓ REGISTERED OWNER INFO GLESBY MARKS 4600 S 134TH PL RENTON WA 98168 D:2068928268 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO ZURICHAMERICA GLA2555495 EXP 11.24 3 4 IN EFFECT &POLICY# 9TOP VEHCLE CHARGE 5 36 EGALLv YES❑NO❑ CITATION# 4AO196794 INATTENTIVE DRIVING o eorrom 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No DD 2534454498 16 a LAST NAME PEREZ-OSORIO FIRST NAME BENITO MIDDLE INITIAL 17 STREET I❑ S❑' 1201 S 18TH ST#2 CITY RENTON ST WA ZIP 98055 4❑ 37 NEW ADDRES 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—TRANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs❑NOF YES F%]NO❑ 19 LDI IVER # STATE WA SEX M M D.C.B. 04 04 1968 39 HELMET {NJURY 7 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE 2 CLASS BACK PAIN ❑ ❑21❑ PLATE# D97035D TATe 41 WA vIN# STFRX5GN2JX123034 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 201E MAKE TOYT MODEL TACOMA STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO BENITO PEREZ-OSORIO 1201 S 18TH ST#2 RENTON WA 98055 D:2534454498 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POINSURGY#E CO GENERAL 9922384IN 1 9TOP 'E""LE CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES N� ❑ s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.JACOBS 1953 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE85814 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5849 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RENGLI JASON (LAST FIRST, ADDRESS&PHONE# 1055 S GRADY WAY RENTON WA 98057 4254307500 SEX M MMDouyvv -�- PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ PQS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ROURKE ADELE ADDRESS&PHONE# D O B 1055 S GRADY WAY RENTON WA 98055 4254307500 SEX I F MMaDYvvv -�_ PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.Q.B.MMDD -❑ YYYY. 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. C.JACOBS 06-03-24 09:33 AM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 6/12/2024 7:26:39 AM BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 6:43 AM TIME POLICE ARRIVED 6:43 AM PART I PAGE IT]OF 4� REPORT NO. EE85814 CASE# 24-5849 OF COLLISION 06/03/24 06:43 OF CbLLI510N NARRATIVE On 6-3-24 at about 0643 1 heard Detective O'Rourke call out with an on-view collision at the intersection of S Grady Way and Lake Ave S. When I arrived on-scene the vehicles were being moved out of the intersection by Banker's towing. I contacted both drivers in or near their vehicles. Both drivers identified themselves via WADL. Driver 1, Jose Ramirez told me; He was driving westbound on S. Grady Way when his phone rang taking his attention away from the roadway. When he looked up traffic had stopped and he was not able to stop in time, rear ending unit 2 in the process. He was shaken up but not injured. Driver 2 was being treated by Renton Fire Authority (RFA). Driver 2 ended up being transported to VMC by ambulance for what appeared to be non-life-threatening injuries. Both vehicles were towed by Bankers towing at the driver's request. I cited Jose Ramirez, for inattentive driving via complaint. This collision occurred in the city of Renton, County of King. I declare under penalty of perjury under the laws of the state of Washington laws that the foregoing is true and correct. C. Jacobs/1953 PAGE 3 OF 4 REPORT NO. EE85814 CASE# 24-5849 DATE AND TIME 06/03/24 06:43 OF COLLISION Lake Ave S t' PAGE 4 OF 4