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HomeMy WebLinkAbout24-7036 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-7036 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cowsloN 07 - 1-- 2024 1751 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LAKE WASHINGTON BLVD BLOCK NO. e✓ 1100 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e HOUSER WAYN 0 2 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2068207575 0 11 30 6 LAST NAME MURILLO PALMA FIRST NAME KELVIN MIDDLE O 1 1 2 31 INITIAL STREET ❑✓ 2812 S 226TH ST CITY DES MOINES ST WA 21p 98198 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID -O B 03 1— 18 — 2002 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� CKC1016 sTArI WAvIN# 5NPD84LF7JH284555 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 5 33 12 3 0 VIN#' VIN# FROM TO VEH.YEAR 2018 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 4 HYUN ELANTR SD DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO KELVIN..L.PALMA 441 WELLS AVE N APT 7 RENTON WA 98057 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE❑ INSURANCE CO NONE IN EFFECT &POLICY# STOP vHICLe CHARGE 1 5 36 LEEGALLv re5�No D CITATION# 4A0313576 IMPROPER PASSING ON LEFT 10 eorrom 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:3606897304 16 a LAST NAME GINTER FIRST NAME TERR► MIDDLE L INITIAL 17❑ STREET �', 1133 LAKE WASHINGTON BLVD F205 CITY' RENTON ST WA ZIP 98059 37 NEW ADDRESS ❑ 18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19[—] DCENSE# STATE AZ SEX F MMr C.B. 03 _ 04 1992 39 HELMET I INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21❑ LICENSE BWV5650 TAre WA VIN1t 5XXGT4L36JG200013 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE pLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2018 MAKE KIA MODEL OPTIMA STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO DANIEL PALMER 1133 LAKE WASHINGTON BLVD N F205 RENTON WA 98059 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO NONE IUR 5 "'LE ❑ ,.I— CITATION# CHARGE LEGALYYES N`LJ25 =HSU AME(PRINT) OFFICER PHONE BADGE OR ID#26 12651 [V7�ENCY A0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE93001 COLLISION REPORT III III III III III 111 1591972 CASE# 24-7036 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) ESTRADA LUD/N (LAST FIRST, ADDRESS&PHONE# DES MOINES SEX M MMDDYYYY 05 - 01 - 1992 ----------------------------- PASSENGER I�I WITNESS[:]UNIT# 1 SEAT7 AIRBAG 1 RESTR. q EJECT ? 1 HELMET INJURY NAruRE of INJURIEs L`!1 USE CLASS ;1 NAME (LAST,FIRST,MIDDLE INITIAL) PIALIOSI SEISO ADDRESS&PHONE# D O B DES MOINES SEX' M MMDDYvvv 11 _ 06 _ 1981 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 1 RESTR. 4 EJECT 1 USE CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) SELESTINO PEDRO AppREss&PHONE# DES MOINES M 01 04 _ 1989 SEX D.O.B. - MMDDYYYY PASSENGER WITNESS UNIT# ! 1 SEAT 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMET NJURY 1 NATURE OF INJURIES ❑ POS. USE CLASS ----� NARRATIVE' Units 1 and 2 both traveling south along 1100 block Lake Washington Blvd N at the signal at Houser Way N. Unit 1 driver makes improper overtaking and passing on the left. Unit 1 driver proximate caue of collision causing non disabling reportable passenger side damage to Unit 1 and non disabling reportable damage to the front driver side of Unit 2. No injuries. Both drivers without proof of valid vehicle insurance. Unit 1 driver cited for improper passing. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 07-05-24 07:04 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT J.CHRISTIANSEN 10437 71512024 7:18:29 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 5:55 PM TIME POLICE ARRIVED 6:04 PM PART I PAGE IT]OF REPORT NO. EE93001 CASE# ' 24-7036 DATE AND TIME 07/05/24 17:51 OF COLLISION .I lli� Bea �Ar 1 is PAGE 3 OF 3