HomeMy WebLinkAbout24-7774 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF00205 170
27
COLLISION REP FIT 1591971
CASE 24-7774 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: 07 — 1—— 2024 2157 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 743
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e S B W e SW 7TH ST
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2068567492 0 11
30
6❑ LAST NAME HASSAN FIRSTNAME IMAN MIDDLE Z 1 1 2 31
INITIAL
STREET ❑, 9621 S 201ST PL CITY KENT ST WA 2jP, 98031 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 01 1— 01 — 1999 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CLF5069 sTArI WAvIN# 3MVDMBCM1RM623815
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 3 2024 MAZE) CX-30 UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 02APG14027801 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY Yes❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2069455379
16 a
LAST NAME CAMARILLO GUERRERO FIRST NAME BLANCA MIDDLE L
INITIAL
17 STREET NEW ADORE57 22004 30TH AVE S CITY DES MOINES ST WA ZIP 98198 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LICENSE# STATE WA SEX F M D.C.B. 01 26 _ 1999 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BZL2426 TArE 41
WA vIN# SKBCP368196501163 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2009 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO BANKERS TOWING YES No�/
REGISTERED OWNER INFO CONCEPTS CREDIT 2326 AUBURN WAYN AUBURN WA 98008 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO NONE STOP 5
VE""LE ❑ Nu
CITATION# CHARGE
LEGi o BOTTOM
ALLY YES
—T
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.EDMUNDS 12576 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF00205
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7774
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MANIVAH VIVIAN
(LAST FIRST,
ADDRESS&PHONE# D O.B.
DES MOINES SEX F MMDDYYYY 12 - OS - 2016
{� SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER ZWITNESS�'UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 6 BUMPED HEAD
NAME
'(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYVYY
PASSENGER []WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 Rainier Ave S in the far right lane between SW 7th and Hardie Ave
SW. Unit 1 was traveling on the same stretch of road, in the center lane. Driver 1 stated she didn't
notice Unit 2 as she merged into the right lane, colliding with UNit 2.
The front end of Unit 1 struck the driver's side of Unit 2 causing significant damage to both vehicles.
Driver 1 provided current registration and proof of insurance. Driver 2 was unable to produce a valid
driver's license, current registration, or proof of insurance. A minor child in unit 2 was not properly
secured in a car seat.
Driver 1 was verbally warned for improper merging which was the proximate cause of the collision.
Driver 2 was verbally warned for no valid operator's license, operating a motor vehicle without
insurance, expired registration, and child carseat violation.
Bankers towing was called for Unit 2. Unit 1 was able to leave under it's own power.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed by E. Edmunds #12576 at 0046 on 07/24/2024 in Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.EDMUNDS 07-24-24 12:47 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 1 7/29/2024 1:19:11 PM
BADGE OR ID# 12576 OR]# WA0171300 TIME POLICE DISPATCHED; 9:87 PM TIME POLICE ARRIVED 10:07 PM
PART I PAGE IT]OF 3�
REPORT NO. EF00205 CASE# 24-7774 DATE AND TIME 07/23/24 21:57
OF COLLISION
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