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HomeMy WebLinkAbout24-12897 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF47142oc� RA COLLISION REPORT 1591971 CASE# 24-12897 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCAI-AGENCY 4250 3 C©DING COUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 0 7 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s o v' 12 - 17 - 2024 1708 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE SUNSET BLVD BLOCK ST e 2700 .= 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 50 00 FEET e✓ S 8 W e HARR/NGTON AV NE OF 6 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:3372923889 0 1 30 5 LAST NAME ALTRAIDE FIRST NAME PEREBO MIDDLE A 1 2 31 INITIAL STREET ❑ 1204 N 10TH PL APT 2120 CITY; RENTON ST WA ZIP; 980575653 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES No F✓ 8 DCIENSE# STATE WA SEXI M MMDDYY' 12 - 26 - 1999 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2 LICENSE, CKW8863 STATE WA V(N#; 4T1G11BK6RU113436 3 10 Fq I as ATP rt TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE# TRLR TRLR 7 1 3 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 2024 MAKE TOYT MODEL CAMRy STYLE SD VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34 13� DAMAGE YES II_II NO ✓ YESII_I) NO✓ REGISTERED OWNER INFO PEREBOALTRA.E1204110THPLAPT2120 RENTONWA98057 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 1 3 14 NAT'L GENERAL 202t493588 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE t 36 Le ALLr yes❑NO❑ CITATION# 70 80TTOM 15❑ sTANowc s 7 UNIT 02 MOTCSR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE CYCLE nWNRR YES NO �/ 16� LAST NAME UNK FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY, RENTON ST ZIP ❑ 37 NEW ADDRESS 1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38 CDL INTERLOCKYES No✓ INTERLOCK YES NO✓ vEs No✓ 19 DRIVERS # STATE SEX U MMDDYY -= � 39 HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG g RESTR g EJECT 9 USE 9 CLASS 0 ❑ 21 PLATE# UNK TATE VIN#LICENSE I 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO NO✓ REGISTERED OWNER INFO UNK RENTON VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &.POLICY# 9TOP YemcLE CITATION# CHARGE t080TTOM EEGAEEY YES❑ NCO 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 HANSEN HSU 12651 WA0171300 PART A PAGE 01 OF 1 3000-345-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF47142 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12897 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST FIRST,MIDDLE INITIAL) UNK LUKE ADDRESS&PHONE 2062288341 SEXi M MMDDDYBYYY — C--------� PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES 1:10 POS. USE CLASS ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYYYY D.O.B. — PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES 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 Unit 1 rear ended by Unit 2 as both were traveling eastbound near the 2700 block of NE Sunset Blvd. Unit 1 slowed for traffic. Unit 2 strikes Unit 1 causing reportable non disabling rear end damage to Unit 1 and unknown non disabling front end damage to Unit 2. Unit 2 does not remain on scene and drives away, last observed eastbound on NE Sunset Blvd, then south along Harrington Av NE. Unit 1 driver was unable to get a license plate of Unit 2, nor did Unit 1 driver observe who was driving. Witness, identified as Luke, reported that they were behind Unit 2 when the collision and hit and run occurred. Witness also did not see the license plate of Unit 2 nor did they observe who was driving. Witness reported Unit 2 as a white smaller older model two door truck, possibly a Toyota pickup truck. No injuries reported. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 12-17-24 06:12 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 12/17/2024 8:45:00 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:10 pry TIME POLICE ARRIVED i 5:15 PM PAST B 3 Da-3m5—attar(t 1Mff) PAGE 2�OF F3 REPORT NO• EF47142 CASE# 24-12897 DATE AND TIME 12/17/24 17:08 OF COLLISION ' s 4 bs ti 5 yF° tOIL , b s s iC a L, �{S s s �x �b a W p PAGE 3 OF 3