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HomeMy WebLinkAbout24-6418 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
24-sa18 z
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 7 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION'. 06 — 18 — 2024 1904 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
126TH AVE SE BLOCK NO. e✓ 16500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 165TH ST
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255595695 0 11
30
6� LAST NAME HERNANDEZ FIRSTNAME ANDREA MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 12708 SE 164TH ST CITY RENTON ST WA ZIP 980585519 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U EETI I INJURY [NATURE OF
CLASS ju BACK PAIN JURIES z❑
3
,OF
P1 ATE 14 BWH4660 JBTATIJ WAV N If 3MZBN1 W38JM161211
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FRom To
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2018 MAZD 3 SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 951333179 3
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
STAIN.D'ING 8 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES NO SOLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRES7
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LLIICENS RIVERIS# STATE SEX U MMDDYY —❑_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑21❑ LICENSE TArE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
TOWED BY Gov HI 44
VEH YEAR MAKE HOND MODEL CRV STYLE UT DAMAGE TOWED TOO✓ BLIN YES NO,/
24❑ REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2
SHADE IN DAGED AREA
2 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE89142
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6418
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
PM 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.
STEVEN FAJARILLO 06-18-24 08:41 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 6/22/2024 11:24:59 PM
BADGE OR ID# ( 12847 ORI# WA0171300 TIME POLICE DISPATCHED; 7:08 Pry] TIME POLICE ARRIVED',7:14 PM
PART I PAGE IT]OF 4�
REPORT NO. EE89142 CASE# 24-6418 OF COLLISION
06/18/24 19:04
OF CbLLI510N
NARRATIVE
24-6418
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 06-18-2024 1 was working as a police officer in the city of Renton. At approximately 1908 hours I
was dispatched to the report of a hit and run collision at 16500 126th Ave SE, City of Renton, County
of King, WA. This incident was captured on my department issued Axon body camera.
According to the notes in the call, a hit and run occurred and the suspect was eastbound on SE 165th
St. Aid was declined.
I arrived at the reporting party's residence. Her vehicle (Vehicle 1) was identified as a blue 2018
Mazda 3 (WA/BWH4660). The driver, owner, and lone occupant of Vehicle 1 was identified as Andrea
Hernandez (DOB:10-08-1993). Vehicle 2 was described as a newer model white Honda CRV. I was
unable to find a license plate for the vehicle. The driver was described as a white female, red hair,
age 20's, unknown clothing.
Andrea was driving north at 16500 126th Ave SE when she saw Vehicle 2 driving south in the wrong
lane of traffic. Andrea turned her wheel to the left to avoid a collision. The passenger side rear quarter
panel of Vehicle 1 side swiped the passenger side of Vehicle 2. Vehicle 2 continued away from the
scene. There was paint transfer on Vehicle 1 and otherwise minor damage. Andrea complained of
back pain but did not request aid.
I photographed the vehicle and damage and later uploaded the pictures to Evidence.com. I provided
Andrea with a case number. Andrea stated she would recognize the driver if she saw her again. She
also stated she would participate in prosecution. Area check for Vehicle 2 yielded negative results.
Vehicle 2 was travelling in the wrong lane of traffic and Vehicle 1 used evasive maneuvers to avoid a
collision. After investigation these actions were the proximate cause of the collision.
There was not enough information to establish probable cause for a suspect in this hit and run
collision.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 06/18/2024 @ 2040 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EE89142 CASE# ' 24-6418 DATE AND TIME 06/18/24 19:04
OF COLLISION
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