HomeMy WebLinkAbout25-1060 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
SASE 25-1060 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 TOTAL#OF OBJECT 1 1 7 28
TRIBAL UNITS 02 RESERVATION STRUCK
z
3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 02 - 1-- 2025 2110 17 ❑.❑ S IN 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DUVALL AV NE BLOCK NO. e✓ 2700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e SE 95TH ST
OF,1 29
MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE
NIT 01 VEHICLE ❑ CYCLE. ❑ YES ✓NO F D:4257329306 2 2 30
6 LAST NAME ZUNIGA GUZMAN FIRST NAME LESTHER MIDDLE 1 1 1 2 31
INITIAL
STREET ❑ 23240 88TH AVE S APT LL 101 CITY KENT ST I WA 2jp, 980313147 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES R No
8❑ LDRIVER # STATE WA SEX'M MID
D-O B 07 — 16 — 1989 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� D66471D sTArI WAurN# 3GCUKSEC8EG254794
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. YRLR. 5 1 33
12 0 0 VIN#' VIN#
2014 CHEV SILVER 4C pL FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 3 DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO 1ES11ER.(14 GUZMAN 1616156THAVE NEAPT 144 BELLEVUE WA 98007 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 ABILI INSURANCE❑ INSURANCE CO NONE 4
IN EFFECT &POLICY# _T_OP__vEBI LE CHARGE 36
LE—Lv YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
UNIT 02 UEHIOCLE CYCLE ❑ PEDESTRIAN ❑ oWNFRRTY ❑ DYES✓ OL
NO D MET PHONE
16❑
LAST NAME NONE FIRST NAME MIDDLE
INITIAL
17❑ STREET CITY KENT ST ZIP
NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LLIICENS # STATE SEX U MMDDYY —�_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE 9 CLASS 0 ❑
21❑ LICENSE I BFC3285 TAre WA VIN# 1HGCR2F83FA054084
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2015 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO PRACHI HETAMSARIA 5259117TH AVE SE BELLEVUE WA 98006 VEHICLE NO.2
SHADE IN DAMAGE$AREA
2 3 �d
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO NONE 1 9TOP
VE"LLE ❑ N`L J
,J� CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES $ '
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12651 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EF63655
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1060
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ZUNIGA KALERO SULMA D
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1616 156TH AVE NE APT 144 BELLEVUE WA 980074371 SEXi F MMDDvyry 07 - 30 - 1977
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# ! 1 SOS. 13 AIRBAG:2 RESTR. 4 EJECT 1 USE CLASS 7 CHEST/HEAD PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL) FLORES ZINION CARLOS Y
ADDRESS&PHONE# D O B
23240 88TH AVE S APT LL101 KENT WA 980313147 4257329306 SEX' M MMnnvvvv 11 _ 29 _ 2009
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 7 AIRBAG 1 RESTR. 4 EJECT 1 USE CLASS 1
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'
Unit 1 traveling north along the 2700 block of Duvall Av NE approaching SE 95th St. Unit 2 was
parked along side of roadway due to icy inclement weather and left abandoned overnight, unoccupied
on Duvall Av NE south of SE 95th St. Unit 1 collides with the rear end of Unit 2, causing reportable
disabling rear end damage to Unit 2 and reportable disabling front end damage to Unit 1. Unit 2 front
passenger complained of pain to head and chest and was treated on scene by Renton Fire and later
transported to hospital for further assessment. No other injuries. Unit 1 driver was unable to furnish
proof of valid insurance for said vehicle. Unit 2 impounded from scene. Proximate cause of collision
was Unit 1 driver exceeding reassonably safe speed to avoid collision with Unit 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 02-02-25 11:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 2/8/2025 4:33:14 AM
BADGE OR ID# ! 12651 ORI# WA0171300 TIME POLICE DISPATCHED 9:98 Pry/ TIME POLICE ARRIVED!9:27 Pry/
PART B PAGE IT]OF 3�
REPORT NO. EF63655 CASE# 25-1060 DATE AND TIME 02/02/25 21:10
OF COLLISION
`Y
�x
4 a
u
kll
F4
ti
L�
t
PAGE 3 OF 3