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HomeMy WebLinkAbout24-6910 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET FIRE ❑ CASE 24-sslo 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION' 07 - 01 - 2024 2007 17 �. S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. e✓ --- ----� ❑ MAIN AVE S MILEPOST 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e S 3RD ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4254522038 0 11 30 6 LAST NAME PONCE GARCIA FIRST NAME CRUZ MIDDLE F 1 2 31 INITIAL STREET ❑ 1713 CAMAS AVE NE CITY RENTON ST WA 2jp, 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ DRIVERS E# ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 I INJURY [NATURE OF INJURIES CLASS ,6 HEAD CUT OPEN NEEDED STICHES z❑ 3 10 1❑ PI ATE 14 CKJ1930 STATE WA VIN#' 1NXBR12E8XZ215816 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM To rRLR. TRLA2 1 5 33 12 2 5 VIN#j VIN#' FROM TO ❑ VEH.YEAR1999 TOYT COROL SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR YMEYERS 7 3 GOVT.VEHICLE 34 13 4 DAMAGE YES NO � YES❑ No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2011516721 4 IN EFFECT &POLICY# TOPVE"'CLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA. YES 1/ NO D:2532171266 16 a LAST NAME HOBBS FIRST NAME SUSAN MIDDLE D INITIAL 17❑ STREET NEW ADDREss❑' 12248 46TH AVE S CITY TUKWILA ST' WA ZIP 98178 4❑ 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 D IVERI # STATE WA SEX F M D.C.B. 11 29 _ 1961 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ 41 21❑ LICENSE I PLATE# CFW4374 TATE WA vIN1 7FARW1H53KE009702 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED BV Gov HI 44 VEH YEAR 2019 MAKE HOND MODEL CRV STYLE $D —FEHICLE TOWED✓ NOO BLIN GENE MEYERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO GEICO 6040-42-63-03IN 9TOP 5 VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM LEGALLY YES N 6 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# FENCY 26 KEV/N PETERSON 12808 A0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE92195 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6910 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' I was dispatched to a collision on 07/01/24 at 2008 hours at Main Ave S and S 3rd St intersection in city Renton, King County WA. Unit 1 CKJ1930 Driver: Ponce-Garcia F. Cruz (DOB 05/30/1978) Unit 2 CFW4374 Driver: Susan D. Hobbs (11/29/1961) Unit 2 D05111 E Driver: Ashley E. Weber (12/23/2003) Unit 3 was at the intersection of S 3rd St and Main Ave S facing east. When the light turned green, she proceeded into the intersection when she was hit on her driver side, she stated that Unit 1 ran a red light. Unit 2 was sitting at the intersection of S 3rd St and Main Ave S facing east. When the light turned green, she went and then told me she was not sure what had happened. Unit 1 was driving South on Main Ave S approaching the intersection of Main Ave S and S 3rd St when the accident happen, he did not explain any further details. Unit 1 was transported to Valley Medical Center to receive stitches. All 3 units were towed off scene. All drivers were given an information exchange. Unit 2 and Unit 3 stated they were fine and no injuries. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 07-02-24 12:54 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 71212024 4:46:27 PM BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 8:08 PM TIME POLICE ARRIVED',8:12 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EE921955 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-6910 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J CYCLE u PEDESTRIAN � OWNER � YEs� NO D:7132547614 0 1 Zg LAST NAME : WEBER FIRST NAME ASHLEY MIDDLE'.. E INITIAL STREET 30 NEW AnDRFSP. 1503 39TH ST CITY ANACORTES ST WA ZIP 98221 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 12 - 23 - 2003 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE D05111E TAr WA VIN# 1FMCU95H05KE01379 PLATE# 9 TRAILER TRAILER PLATE If STATE PLATE If STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 2 5 VEH.YEAR2005 MAKE FORD MODELESCAPE STYLE SD I VEHICLE TOWS ET SABLI T�'W,6y'ERS GnVT VFHIGP FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO OWNED BY DRIVER ] 3 33 12 SHADE IN DAMAGED AREA 4� FROM TO LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 00673853.0 gl"OI' IN EFFECT &POLICY# VEHICLE 70 BDrroM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE pp�� STANDING } MOTOR g 7 6 14 ❑ UNIT Tr Vd 1 RE O CYDDAL OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME N!I IAL MIDDLE ❑ 36 STRE 16 ET NEW ETnnR"� CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE If 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 07-02-24 12:54 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26F7 OR ID# 12808 O#I WA0171300 SUMMERS 7/2/2024 PAGE F3 OF 3000-345-013(R 11118) REPORT NO. EE92195 CASE# 24-6910 DATE AND TIME 07/01/24 20:07 OF COLLISION ON 011, 411 V� � to Y � �" k�l';". �,,,� �:.,, { �.: { �x�s awS.{,,.v � S i { .'Hpp�). SsoiHA}SiS ,. . PAGE 4 OF 4