HomeMy WebLinkAbout24-8642 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
SASE 24-8642 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 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' 08 - 1-- 2024 1709 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SHATTUCKAVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2065578723 0 4 30
6 LAST NAME GARCIA GONZALEZ FIRST NAME GERARDO MIDDLE 1 2 31
INITIAL
STREET ❑✓ 2307 NE 4TH ST CITY RENTON ST WA ZIP 98056 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 I I [NATURE OF INJURIES
H U EET 2 1 INJURY CLASS ,6 CUTS ON ARM AND SOME COMPLAINTS OF PAIN z❑
3
10[1P1 ATNES# CHN6841 sTAr WAu N# 3FA6POH75ER214440
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR 2014 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 34
13 4 FORD FUSION SD DAMAGE YES NO �MEYERS 1 3 YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO NA 4
IN EFFECT I SUR N#VEHICLE CHARGE 5 36
LEGALLYYEs❑NO CITATION# C:��
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:9999999999
LAST NAME CUMMINGS FIRST NAME HAROLD MIDDLE R
INITIAL
17❑ STREET NEW ADOREss❑' 8242 S 120TH ST BLDG SEATTLE CITY SEATTLE ST WA ZIP 98178 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 DRIVER # STATE WA SEX M M.C... 12 _ 04 1939 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 F—NATUR OF INJURE
H EET 2 NJAU SY 6 CUTS SORENESS AND PAIN ❑ 40
❑ILICENSE 21❑ PLA E# BNP1217 TArE 41
WA VIN# JTMRFREV3HJ126003 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2017 MAKE TOYT MODEL RAV 4 STYLE UT I VEHICLE TOWED TO BLIN TOWED II GOV HI 44
24❑ DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO HAROLD CUMMINGS 8242 S 120TH ST BLDG SEATTLE SEATTLE WA 98178 D:9999999999 VEHICLE NO.2
SHADE DAGELLCddAREA
LIABILITY
INSURANCE 8 POINSURGY#E CO FOREMOST 8813941340
IN CTOP
VEHICLE ❑ CITATION# CHARGE 1�1 BOTTOM
LEGALLY YES NC[:]
25 7KEV
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [ZoNCY
26
PETERSON 12808 171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF06206
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8642
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SCHWARTZ CADEN R
(LAST FIRST,
ADDRESS&PHONE# D O.B.
8242 S 120TH ST SEATTLE WA 98178 2062714903 SEX M MMDDYyry 08 - 01 - 2004
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESS❑ UNIT# 2 POS 3 AIRBAG;6 RESTR. 4 EJECT 1 USE 2 CLASS !6 CUTS AND PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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 08/16/24 at 1710 hours Airport Way and Shattuck Ave S, in city
Renton, King County WA.
Unit 1 CHN6841 Driver: Gerardo Garcia-Gonzalez (DOB 01/08/1991)
Unit 2 BNP1217 Driver: Harold R. Cummings (12/04/1939)
Unit 2 told me they were facing South leaving the light at Airport Way and Shattuck Ave s to make a
left turn and head East onto Airport Way. When turning they stated Unit 1 blew through the red light
and smashed into their vehicle causing it to rollover onto its side. The driver of Unit 1 got stuck in the
vehicle due to not being able to move his seatbelt and had to wait for fire to remove him from the
vehicle. Unit 2 told me that Unit 1 never slowed down before hitting him.
Unit 1 told me he was not sure what happen and was unable to really talk to me just keep saying he
did not know.
A witness stated that Unit 1 ran the red light and hit Unit 2.
The crash is consistent with Unit 2's recall of the incident.
Both drivers were treated on scene by fire and then transported to medical facility for further
evaluation.
Upon request Gerardo was unable to provide proof of insurance that was valid and was cited for
driving a motor vehicle without insurance. Gerardo was driving without a valid drivers license and was
cited for driving a vehicle without a valid operator's license.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 08-17-24 12:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 811812024 9:49:57 PM
BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 5:10 PM TIME POLICE ARRIVED 5:14 PM
PART I PAGE IT]OF 3�
REPORT NO. EF06206 CASE# ' 24-8642 DATE AND TIME 08/16/24 17:09
OF COLLISION
3
5' tl
s �
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