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HomeMy WebLinkAbout24-9404 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 SASE 24-9404 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT&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# cowsloN 09 - 1-- 2024 1535 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE PETROVITSKY RD BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 120THAVESE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4255479623 0 11 30 6� LAST NAME RAMIREZAGUIRRE FIRSTNAME JOSSELYN MIDDLE / 1 2 31 INITIAL STREET ❑ 12122 SE PETROVITSKY RD CITY RENTON ST WA ZIP 980586616 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ P1ATE14 A7705712 STATE WA VIN# 1FTFW1ET66KD91860 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 1 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 2 2011 FORD F150 PK DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO KEVIN LOPEZ JUAREZ 12122 SE PETROVITSKY RD RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 3 4 14 2 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP 5 VEHlcl.e CHARGE 10 BOTTOM 36 LEGALLY YES❑NO❑ CITATION# 4A0598499,4A0598499 OP MOT VEH W/OUT INSURANCE, 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068773664 a LASTNAME FRASER FIRSTNAME JONATHAN MIDDLE INITIAL 17 STREET I❑ S❑' 16704 117TH AVE SE CITY RENTON ST WA ZIP 98058 4❑ 37 NEW ADDRES 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE WA SEX M D.C.B. O6 _ 19 _ 1969 39 LICENSE# MMDDYY W USE EET INJURY [-�A—TURE OF INJURIES POSSIBLE BROKEN WRIST ❑ 40 20❑ ON DUTY STATUS AIRBAG,2 RESTR y EJECT 1 5 ❑21❑ PLA E# C36681Z TATe 41 WA VIN# 1GCFC24H1MZ189952 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 1991 MAKE CHEV MODEL GSERIES STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 24❑ DAMAGE YES NO GENE MEYER TOWING YES NO REGISTERED OWNER INFO JONATHAN FRASER 16704117TH AVE SE RENTONWA98058 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO STOP 5 LE L..LLY YES❑ NC[:]J� CITATION# CHARGE to BOTTOM LEGA6 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 JESSE VANDERHOEK 11631 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF12970 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9404 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MEDOWS SANDRA (LAST FIRST, ADDRESS&PHONE# D O.B. 2065040330 SEXi F MMDDYyry 01 - 15 - 1971 --------------------------- PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) 1 GARCIA JORGE ADDRESS&PHONE# D O B 2068566749 SEx' M MMJDvvW 04 - 23 - 1991 PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES []WITNESS POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Two separate witnesses advised that vehicle #1 was driving eastbound on SE Petrovitsky Rd, and then attempted to turn left into a driveway. The witnesses advised vehicle #2 was driving west on SE Petrovitsky Rd. The witnesses stated vehicle #1 turned left, directly in front of vehicle #2, and did not yield the right of way to vehicle #2 as is required by law. This caused the front left corner of vehicle #1 to collide with front left corner and left side of vehicle #2. It should be noted that there were no traffic signals at this location. Based on the totality of the circumstances, it appears the actions of vehicle #1 were the proximate cause of this collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JESSE VANDERHOEK 09-07-24 06:34 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 9/8/2024 10:23:11 AM BADGE OR ID# 11631 OR]#+ " WA0171300 TIME POLICE DISPATCHED 3:39 PM TIME POLICE ARRIVED i 3:44 PM PART I PAGE 2�OF❑ REPORT NO.! EF12970 CASE# ' 24-9404 DATE AND TIME 09/07/24 15:35 OF COLLISION r � Am N Ilr ��4 } 1 n e PAGE 3 OF 3