HomeMy WebLinkAbout24-10278 ("7— STATETcN 27CERAFFi O EF22198 COLLISION REPCF 1591971 CASE 24-10278 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 1 STATE ROUTE OTHER STOLEN vEwCLE ❑ LOCALAGENC, 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TRIBAL UN TS#OF 02 STRUCK' 1 8 2$ RESERVATION: 2 3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# coislo� 10 - 01 - 2024 1615 17 �.� S e W e OF 8 IN ?070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NONINTERSECTION ❑✓ TALBOT RD S BLOCK NO. 8 1200 .� 4a❑ MILEPOST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 350 MILES N 1. 00 FEET e✓ S e OF SGRADYWAY 2 0 29 MOTOR PEDAL- DAM ETT PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ Yes NaO ,/ D:2063532004 0 1 30 6 LAST NAME SEBASTIAN FIRST NAME JOHN MIDDLE F 1 1 2 31 {N{TIAL STREET [:] 1100 SW 3RD PL CITY RENTON WA NEW ADDRESS ST {P 98057 2 7❑ CDL fGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1NTERLOCKYEs NO INTERLOCKYEs No YEs NO 8❑ LDRIV STATE WA SEX'D M LO S 08 - 17 - 1985 1 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT ? H USE T CLA RSY ? NATURE OF INJURIES 2= �ci ATF# 528ZLY srnr� WA uIN# 2T1 CE22P62C014319 3 10 9❑ 11 3 5 PLARA TE# STATE PLATE# STATE ROM To TRLR. TRLR: 5 1 33 12 3 5 VIN# VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 2❑ 2002 TOYT CAMRY DAMAGE YES NO ✓ YE,[_] NO 5 1 34 REGISTERED OWNER INFO UGHN SEBASTIAN 11.SW 3RD PL RENTON WA 98057 D:2063532004 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO SAME. 4 IN EFFECT &POLICY# 9TOF vtwc�t CHARGE ❑ 36 Fcnuv YES❑NO❑ CITATION# t t0 BOTTOM $ 15❑ STAND NG 8 7 6 1 MOTOR PEDAL- .PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE ❑ ❑ OWNER YES)/ NO D:2066653668 16F1 LAST NAME ROSALES DE RIVAS FIRST NAME YES/CA MIDDLE V INITIAL 17 STREET 14428 25TH AVE S CITY SEATAC ST' WA ZIP 981684206 37 NEW ADDRESS 18� IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 CDL INTERLOCK YES NOF INTERLOCK YES Nb YES NO 19 DRIVERS: STATE WA SEX F 1 D.O.B. O6 22 199? 39 LICENSE# MMDCWY - 20❑ ON DUTY El STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM USEET CLASS 1 NATURE OF INJURIES ❑ 40 21❑ LICENSE,CA60584 rArE WA VIN# 2HGFB2F92FH538159 ❑ 41 PLATE# ILER TRAILER ❑22❑ PLATE# STATE PLATE# STATE 42 23 4 TRLR RLft VIN#. IN# 3 VEH.YEAR 201$ MAKE HOND MODEL (',IV/(, STYLE VEHICLE TOWED TO BLIN TOWED BY GO HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO GUILLERMO RIVAS RAIMUNDO 500 MILL AVE S RENTON WA 98057 VEHICLE NO.2 SHADE IN DAMAGED AREA INSURANCE CO 3 4 LIABILITY INSURANCE PROGRESSIVE 966490297 IN EFFECT &POLICY# i 4TOP 5 veeia..e ❑ ITATION# CHARGE tOBOTTOM FFrAFFY YES INC]`'L J 25� a 7IFFLIIERS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 VERTON 2517 WA0171300 PARTA3000-345-159 FIR11nst PAGE 01 OF STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF22198 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10278 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. - MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES 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 GRY/2 LN 1 SLV/1 LN 2 LN CNG INTO SIDE RTF Within the city limits of Renton/King/WA I responded to a 2 vehicle crash that occurred near the 1200 block of Talbot Rd S. I contacted the driver of unit 2 who explained that she was northbound in lane 1 Talbot Rd S. She told me that unit 1 changed lanes into the side of her vehicle. The damage was minor. She did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 1. He told me that traffic in lane 1 had slowed because a vehicle was turning towards the parking lot of Home Depot. He said he observed a gap in traffic and believed he had a safe space to change lanes and did not see unit 2 and brushed the side of her car. He did not complain of injury and damages was minor and did not require a tow truck. Information/Insurance only. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. M.Leverton/2517 City of Renton/King/Wa 10/02/2024 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 10-02-24 07:11 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 101712024 12:37:06 PM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:16 PM TIME POLICE ARRIVED i 4:16 PM PART B 8800-845.160(R1Vt8) PAGE 0 OF 37 REPORT NO. E F22198 CASE# 24-10278 DATE AND TIME 10/01/24 16:15 OF COLLISION sx v n s i �I ,ram tilt t h� =.a c � tt Y u 2 t t b 1 > t .�191str,3 5���\ ..`2�fsxSu s .L���S tf~•\1:: s t. ,FF 7,f �y?, �rf�7�� `-� °t'lq'� 3 .l�,,,y�k tq � �:. •y i >t?t4 3^ S to t a glzf tt� t ti PAGE 3 OF 3