HomeMy WebLinkAbout25-649 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF59160oc� RA
COLLISION REPORT 1591971
❑ 0✓ RESULTED I
CASE 25-649 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LQCAI-AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 01 - 20 - 2025 1154 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e 4700 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8 W e DUVALL AVE NE
OF 4 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4254910392 0 1 30
6❑ LAST NAME CASILLAS CORTES FIRST NAME DAVID MIDDLE I 1 2 31
INITIAL
STREET Q 23908 BOTHELL EVERETT HWY APT CITY; BOTHELL ST WA ZIP' 98021 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO%/ INTERLOCKVEs NO�/ YEs NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' O6 - 07 - 1999 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY ? [NATURE of INJURIES 2
LICENSE, CCN5573 STATE WA VIN#; 1D4RD2GG3BC615849 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
rRLR rRLR. 7 1 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2011 MAKE DODG MODEL DURAN STYLE GA VEHICLE TOWED fj TO ZBLIN TOWED BY GOVT VEHICLE 3 7 34
13 DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO JUAN BAXIN GONZALEZ 1919196TH ST SW UNIT 63 LYNNWOOD WA 98036 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
❑ ElNSURANCE CO 3 4
14 LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
V""' CHARGE tO BOTTOM 5 36
15
srnNowc yes❑NO❑ CITATION# 5A0005653,5A0005653, OP MOT VEH W/OUT INSURANCE,NO 7 e
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:4253658046
16�
LAST NAME WANG FIRST NAME ARIKA MIDDLE S
INITIAL
17 F1 STREET ❑❑ 16513 NE 13TH ST BELLEVUE WA9 CITY' BELLEVUE ST, WA ZIP 980080000 4 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES NO INTERLOCK YES No YES NO
19 DRIVER'S STATE WA SEX F I D. 08 12 2004 � 39
LICENSE# MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS SORE NECK
21[—] LICENSLATE E CBX9640 TATE WA VIN# 1NXBR32E45Z397703 41
22❑ PLATE# STATE PLAAILER
TE# STATE 42
23 r TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2005 MAKE TOYT MODEL COROLL STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO CHUNG-KUANG WANG 16513 NE 13TH ST BELLEVUE WA 98008 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 4952693F26.47C
IN EFFECT &POLICY# t
HICL
LE— YES❑ N CO, CITATION# CHARGE U
VEE
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF59160
COLLISION REPORT III III III III III 111
1591972 CASE# 25-649
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
RTF
On 01-20-2025 at about 1154 hours, I was sent to a collision which took place in the 4700 block of NE
4th St, in the City of Renton, King County, Washington.
Upon arrival both drivers had the same account of the collision.
The driver of unit 2 informed me that she was traveling westbound in lane 1 the right turn lane. She
was going straight and driving about speed limit. Suddenly unit 1 turns in front of her from the double
left turn lane and they both collide.
The driver of unit 1 said he was in the double left turn lane when cars in lane 3 and 2 allowed him to
make a left turn lane. When he made his turn, he and unit 2 collided in lane 1. He did not yield to unit
2 who was going straight.
Upon request the driver of unit 1 Casillas Cortes, David (06-07-1999) was not able to provide me with
a valid driver's license. He only had a WAID. I ran his name and he did not have a valid driver's
license.
He was also not able to provide insurance upon request.
David was in the double left turn lane and tried to turn into a private driveway to go to work. He did
not yield to unit 2 and his actions is a contributing factor in the collision.
David was cited for NVOL 2, no insurance, and vehicle turning left.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 01-23-25 08:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVECRY DATE
J.TRADER 4553 112412025 2:13:29 PM
BADGE OR ID# 10065 ORI# WA0171300 TIME POLICE DISPATCHED 11:54 AM TIME POLICE ARRIVED i 11:54 AM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. E F59160 CASE# 25-649 DATE AND TIME 01/20/25 11:54
OF COLLISION
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