HomeMy WebLinkAbout24-6333 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-6333 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
Ct ELISION' 06 - 1-- 2024 1821 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HOQUTAMAVENE BLOCK MILEPOST ST e✓ 1000 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NE 10TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3608018334 0 11
30
6� LAST NAME ADAMS FIRSTNAME JORDAN MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 25008 146TH AVE SE CITY KENT ST WA 2jp, 980423409 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 9 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� C98824R sTArI WAurN# 1 FTYR3XM3KKB33667
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 2 2019 FORD TRANSI CG DAMAGE vEs 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO ASLAR LOGISTICS LLC 940 RIDGEBROOK RD SPARKS MD 21152 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 LIABILITY INSURANCE OLD REPUBLIC ALA166345.28
LI EFFECT I SUR N# TOPVEH" CHARGE <1�3
OTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 4A0359551 FAIL STOP AT STOP 5
15❑ STANDING 6
MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U-NIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2062956417
16 a
LAST NAME WHITE FIRST NAME DEREK MIDDLE J
INITIAL
17 NEWEETR 7' 809 DUVALL PL NE CITY RENTON ST WA ZIP 980594598 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.O.B. 10 _ 01 1981 39
LICENSE# MMDDYY
F—NATURE OF INJURIES
20❑ ON DUTY STATUS AIRBAG 9 RESTR 4 EJECT 1 H U EET LASSY H COMPLAINT OF SHOULDER PAIN ❑ 40
❑ILICENSE 21❑ PLATE# 509NZP TArE 41
OR VIN1 1GT49ME73PF174642 1
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2023 MAKE GMC MODEL SRp STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO PHOENIX ASPHALT MAINT 605 SE LAKE RD REDMONDOR97756 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO OREGON MUTUAL OM0926072IN IU�VE"LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
RYAN KARLO RIVERA 1
12649 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE92143
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6333
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
POS. 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.
RYAN KARLO R/VERA 06-17-24 03:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 71212024 2:20:01 PM
BADGE OR ID# 112649 ORI#' WA0171300 TIME POLICE DISPATCHED 6:24 PM TIME POLICE ARRIVED',6:30 PM
PART I PAGE IT]OF 5�
REPORT NO. EE92143 CASE# 24-6333 OF COLLISION
06/16/24 18:21
OF CbLLI510N
NARRATIVE
On 06/16/2024, 1 was working uniformed patrol in a marked police vehicle as 3R23. At approximately
1824ours, officers were dispatched to an unknown injury collision at the intersection of Hoquiam Ave
NE/NE 10th St, which is located within the city limits of Renton, county of King, Washington. This
turned out to be an injury accident. Dispatch advised that witnesses were calling in a collision in the
area involving 2 vehicles.
Officer J. Weber initially responded to the call and collected information on the details of the crash.
When I arrived at the call location, I spoke with Officer J. Weber. He identified the involved vehicles
as Unit 1 and Unit 2 respectively.
Officer J. Weber said that Unit 1 was headed westbound on NE 10th St approaching Hoquiam Ave
NE. Unit 2 was headed southbound on Hoquiam Ave NE approaching NE 10th St. Unit 1 has a stop
sign before the intersection, Unit 2 does not. Unit 1 began to continue westbound on NE 10th St to
cross Hoquiam Ave NE and collided with the driver's side of Unit 2.
1 was able to speak to the driver of Unit 1. He stated a similar story as described above.
When I observed Unit 1's vehicle, I noticed that there was a large dent and scratches that were on the
road along the entire front end of the vehicle. Unit 1's driver stated a was seat-belted.
Unit 1 was the only occupant of the vehicle. He stated she was uninjured.
I was then able to speak with the driver of Unit 2. He stated a similar story as described above.
When I observed Unit 2's vehicle, I noticed that there was a large dent and scratches that were along
the entire driver's side front and back door panel area of the vehicle. Unit 2's driver stated he was
seat-belted.
Unit 2 was the only occupant of the vehicle. He stated that he had slight pain in one of his shoulders.
Based on the fact the driver of Unit 1 had not made a complete stop prior to entering the intersection
to cross over, I found reasonable cause to cite the driver of Unit 1 for RCW 46.61.190.2 -Vehicle
entering stop of yield intersection (failure to stop at stop sign/intersection). I completed a SECTOR
infraction for Unit 1 and sent it to the prosecutor queue to be mailed to him.
Both vehicles were towed by Gene Meyers from the location.
An exchange of information was provided to both parties before they left the scene.
Based on the above described, Unit 1 appears to be the proximate cause of the collision.
This report is for informational purposes only to document the collision.
This concludes my report.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Signature: Ryan Rivera (#12649) Date and Place: 06/17/2024 @ Renton, WA
PAGE 3 OF 5
REPORT NO. EE92143 CASE# 24-6333 OF COLLISION
06/16/24 18:21
OF CbLLI510N
NARRATIVE
PAGE 4 OF 5
REPORT NO. EE92143 CASE# ' 24-6333 DATE AND TIME 06/16/24 18:21
OF COLLISION
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