HomeMy WebLinkAbout25-1509 �, N,... ITFC II IIIII III IIIII II IIII IIIII I . 27I OLCERAF EF66579
COLS-'J'®N RERT 1591971
❑ FIRE ❑ CASE 25-1509 2 0 5
INTERSTATE CITY STREET ✓ RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL UNITS 8
TOTAL S#OF 02 SO7RUCK BJECT 1 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 02 - 17 - 2025 0642 17 =.�� S W e OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
SW 43RD ST BLOCK NO. e 1400 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1500 FEET e✓ S 8 W e OAKESDALE AVE SW
0 1 29
MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:7025445213 0 9 30
5 LAST NAME SALAS DURAN FIRST NAME RICARDO MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 1685 14TH PL NE CITY ISSAQUAH ST WA ZIP 98029 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPQRTED 3
IN7ERLOCKYES Na✓ INTERLOCKYES NO✓ YES No�/
8 DRIVECEN STATE WA SEX MMOr YY' 08 - 03 - 1996 t 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET CLASS 1 NATURE OF INJURIES 2
LICENSE, CNS0796 srArE WA VN# 3GYFNBE31ES547105 3
10 19� PI ATP tt
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FRON TO
TRLR TRLR 7 3 33
12 3 5 VIN# VN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN �tpyEN�{"(g GOVT VEHICLE 9 9 34
13 2 2014 CADI SRX 4H DAMAGE YES NO "'"' RS YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 4TOP
ic CHARGE 5 36
Lemur yes❑NO❑ CITATION# HARE 7 o BOTTOM
15❑ sTnNowc B 7 e
III MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2065911746
16�
LAST NAME SHOREY FIRST NAME JOHNATHAN MIDDLE I A
INITIAL
STREET ❑
17 F1 NEW ADDRESS'❑ 31323 11TH PL S CITY I FEDERAL WAY I ST, WA I ZIP 98003 1 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYEs X YES NOF,/Il yEs No✓
19 DRIVER'S STATE WA SEX M MDD 04 08 1991 39
LICENSE# MD.O.B, -
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CDL4893 TATE WA vIN# JTMDJREV5GD008007 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR
176 43
UIN#. 'IN#.
VEH.YEAR 2016 MAKE TOyT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT &POLICY# t 9TOP
vewae , CITATION
CHARGE tO BOTTOM
A r YES N`LJ.I—I
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
2
R.ONISHI
6 5738 WA0171300
PAGE 01 OF 1
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF66579
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1509
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} BASANES PRINCESS S
(LAST,FIRST,
ADDRESS&PHONE# DOB
3123 11TH PL S FEDERAL WAY WA 98003 2065578223 SEX' F MMDDYYYY 09 — 19 — 1994
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS ,UNIT 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 7 COMPLAINT OF HEAD PAIN
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS USE CLASS r— ----j
NARRATIVE
Unit 2 stopped in eastbound left lane, turning into driveway of 1600 SW 43rd St. Unit 1 ran into rear of
unit 2. Driver 1 Salas Duran claimed that unit 2 had "brake checked" him; driver 2 Shorey said that he
had been stopped with his left turn signal on to turn into a driveway on the north side of the road when
Salas Duran ran into him. Salas Duran had odor of alcoholic beverage on breath, and was arrested
after voluntary field sobriety tests. Salas Duran submitted a breath sample of .176; please see Officer
Steed's narrative for his observations and actions on the DUI. Salas Duran's criminal history revealed
three prior convictions on DUI arrests in Nevada since 5/15/2017, and he was booked for Felony DU1.
Salas Duran did not have a valid license status at the time of the collision; misdemeanor citation for
that offense held pending disposition of the felony charge.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 02-17-25 12:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.THIELMAN 11462 211712025 5:04:28 PM
BADGE OR ID# 5738 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:44 AM TIME POLICE ARRIVED 6:52 AM
PART B 3aaa-345-,aa(RI1Y1s) PAGE 27OF 37
REPORT NO. EF66579 CASE# 25-1509 DATE AND TIME 02/17/25 06:42
OF COLLISION
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