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HomeMy WebLinkAbout24-6826 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SAS 24-6826 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HIT& F ❑ LOCAL AOENC 3
HIT 8 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# ❑
COLLISION 06 - 1-- 2024 0106 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SWGRADYWAY
1 9 29
UNIT 01 MOTOOR Z PEDDAL ❑ YESAGE NHORE✓LDMET PHONE O 1 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO INTERLOCK YES NO YES No
8 DRIVER'S STATE SEX U D Q.B. 2 32
❑ LICENSE# MMDDYY -� 1
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 9 H USE
9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ PI ATpS� UNKNOWN sTATI WA VIN#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM TO
rRLR. TRLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13❑ DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN RENTON WA 98057 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT
VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:4259193778
16 a
LAST NAME LIQUIDO FIRST NAME RICARDO MIDDLE A
INITIAL
17❑ STREET ❑', 1204 N 10TH PL APT 2549 CITY' RENTON ST WA ZIP 98057 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑NO� INTERLOCK YEs❑NoF-] YES❑NO
19[—] DRIVER'S STATE WA SEX M I D.O.B. 04 19 _ 1963 39
LICENSE# MMDDYY
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT ''9 USE 9 CLASS 1 ❑
21❑ LICENSE I BPE7948 TATe WA VIN. 5TDDK3DC2CS037618
❑ 41
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE PLATE#ILER STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2012 MAKE TOy7- MODEL SIENNA STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO RICARDO LIQUIDO 1204 N 10TH PL APT 2549 RENTON WA 98057 D:4259193778 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSURANCE
#E CO GEICO 6132-84-53-11IN IGQVE"LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=TAMAIVENA
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12812 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE94137
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6826
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'
Unit 2 was traveling southbound on Rainier Ave S in lane 2, approaching SW Grady Way. They
stopped at a red light, and an unknown pickup truck struck the vehicle's passenger side. Unit 2 stated
that the suspect's vehicle was in lane 1 and attempted to turn into lane 2 because lane 1 is only a
right turn onto SW Grady Way. Unit 1 pulled over before entering 167 going southbound when the
unknown suspect turned into Highway 405.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
S/TIVENI TAMAIVENA 06-30-24 01:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 7/3/2024 11:41:56 PM
BADGE OR ID# 12812 ORI# WA0171300 TIME POLICE DISPATCHED'; 1:12 AM TIME POLICE ARRIVED',4:20 AM
PART I PAGE IT]OF
REPORT NO. EE94137 CASE# 24-6826 DATE AND TIME 06/29/24 01:06
OF COLLISION
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