HomeMy WebLinkAbout24-9387 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-9387 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 09 - 1-- 2024 2005 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV e NE 10TH ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ N:4253065083 30
6 LAST NAME HERRERA SANCHEZ FIRST NAME JOSE MIDDLE 1 2 31
INITIAL
STREET ❑ 962 SUNSET BLVD NE#C5 CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CCY3753 sTArI WAvrN# 2G1 W655K879106345
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ vIN#' UIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13❑2 2007 CHEV IMPALA 4D DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑ SHADE IN DAMAGED AREA ❑ 35
14 LIABILI V INSURANCE INSURANCE CO UNKNOWN 3 4
IN EFFECT &POLICY#
15❑ vECEHA"LE 5 36
LLLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
STAIN,DIING 8 7 6
UNIT U2 VEHIMOTOCLE ❑ CYCLE ❑ PEDESTRIAN ❑PEDAL ✓ oWNFRRTY ❑ DYES✓ NO OLD MET PHONE
16❑
LAST NAME MULLEN FIRST NAME RORY MIDDLE M
INITIAL
17 STREET❑ NEW ADOREss❑' 13050 48TH AVE S CITY TUKWILA ST WA ZIP 98168 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 09 _ 18 _ 1979 39
LICENSE# MMDDYY
NATURE OF INJURIES
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT H U EET 2 LASSY 7 LACERATION ON RIGHT ARM/PAIN ❑ 40
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 Q 2 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ
VEHICLe ❑ ,.I— CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7,L
CER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
LI M RIDGEWAY 12500 WA0171300
A
26
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF12968
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9387
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
PM USE CLASS
NAME
'(LAST,FIRST 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
W/LLIAM RIDGEWAY 09-06-24 11:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 9/8/2024 10:23:26 AM
BADGE OR ID# 12500 ORI#' WA0171300 TIME POLICE DISPATCHED 8:05 Pry] TIME POLICE ARRIVED:8:08 Pm
PART Ei PAGE IT]OF 4�
REPORT NO. EF12968 CASE# 24-9387 OF COLLISION
09/06/24 20:05
OF CbLLI510N
NARRATIVE
**INFO ONLY**
At about 2007 hours on 09/06/2024, 1 was dispatched to an unknown injury accident that occurred at
NE Sunset Blvd and NE 10th St in the City of Renton, King County, Washington. A passerby was
reporting a possible vehicle vs pedestrian. The pedestrian was up and possibly walked to Safeway
(2725 Sunset Blvd NE).
Upon arrival, the pedestrian, who was later identified as Rory M. Mullen (DOB:09/18/1979 -verified by
WADL photo) was located at Safeway. He was observed with drug paraphernalia (foil and tudor) in
his lap. He was favoring his right arm. Renton Fire arrived and observed a laceration on his right arm.
Rory said his right leg was struck but was okay. FIRE recommended he seek further medical
attention at the hospital. Rory refused and refused to sign their refusal form. I told Rory he was being
recorded and attempted to hear his side of the story. He said he was walking across the crosswalk.
Rory then walked away and wanted nothing to do with the police or fire department.
The involved vehicle, a white 2007 Chevrolet Impala, driven by the registered owner: Jose Herrera-
Sanchez (DOB:01/27/1960 -verified by WADL photo) said Rory was crossing the crosswalk without
the signal 0-walking). Jose was unable to stop in time before he saw him. Jose was traveling
eastbound NE Sunset. There was minor damage to the front of the Impala, but Jose did not want a
police report and only wanted to ensure Rory was okay. Jose said he would take care of the damages
to his vehicle personally because a transient wouldn't be able to pay anyways. Jose's daughter
Monica (425-306-5083) was nearby in another vehicle and confirmed Jose wanted no police
involvement. Jose had no injuries.
This concludes my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by W. Ridgeway#12500 on 09/06/2024 at 2321 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO.! EF12968 CASE# 24-9387 DATE AND TIME 09/06/24 20:05
OF COLLISION
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