HomeMy WebLinkAbout24-8691 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SAS 24-8691 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
GawsloN 08 - 18 - 2024 0820 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BRONSONWAYNE
0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6❑ LAST NAME ESCOBEDO FAJARDO FIRST NAME JORGE MIDDLE L 1 0 4 31
INITIAL
STREET ❑ 2618 NE 9TH ST CITY RENTON ST WA 21p 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 11 — 30 — 2005 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CKS8158 sTArI WAvrN# 3N10E2CP3FL411362
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 6 1 33
12❑ vIN#' VIN#
FROM
34
13� VEH.YEAR 2OI S MAKE NISS MODEL SENTRA STYLE 4D IV
AMAGE TOWED NOO pLSABLIN TSIYYEp9vMEYERS VEHICLE�
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO ELIZABETH FAJARDO ESPINO 2618 NE 9TH ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,DIING 7 6
UNIT U2 VEHICCMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
/SABELLA DAN/LYUK 13001 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF07470
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8691
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRS MIDDLE INITIAL)
ADDRESS&PHONE# D D B
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'
ESCOBEDO FAJARDO, JORGE LUIZ (DOB 11-30-2005) using language line stated that he was
traveling in the white Nissan Versa (CKS8158) northbound on SUNSET BLVD NE and due to the
condition of the road and state of his tires, he lost control on the slight curve uphill and drifted into the
middle divider in the center of the roadway which was dividing northbound and southbound travel on
SUNSET BLVD NE.
Jorge stated that as he was attempting to avoid impact with the divider, he over corrected the wheel
still hitting the divider, but after which jolted the vehicle to the right side of the northbound lane. He
attempted to avoided by turning back into the median.
He stated he collided with the median for a second time and due to both over corrections and speed
at which he turned the wheel, had little control of the vehicle and spun-out colliding with the barrier of
the southbound lane and slid down southbound.
I noted tire marks in the dirt off the barrier going southbound and he stated that after the vehicle
stopped, he attempted to back up to get his vehicle out of the roadway shorty after which the vehicle
stalled out and died.
ESCOBEDO FAJARDO, JORGE LUIZ (DOB 11-30-2005) provided a state identification card and
upon running his information he did not have a valid operating driver's license
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ISABELLA DANILYUK 08-18-24 06:50 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1 8/22/2024 12:28:52 PM
BADGE OR ID# 13001 ORI# WA0171300 TIME POLICE DISPATCHED 8:23 AM TIME POLICE ARRIVED'8:Y9 AM
PART I PAGE IT]OF 4�
REPORT NO. EF 7 70 CASE# 2 aeg] A m°M\ O&1@2 0:2
« : COLLISION <
\
GE 3 0 4
REPORT NO. EF07470 CASE# ' 24-8691 DATE AND TIME 08/18/24 08:20
OF COLLISION
i;
am t,,
PAGE 4 OF 4
