No preview available
HomeMy WebLinkAbout24-11014 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF28551 1 9 27 COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE$# 24-11014 2 0 5 INTERSTATE CITY STREET RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION' 10 - 1-- 2024 1928 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ EDMONDS AVE NE BLOCK NO. e 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e NE SUNSET BLVD 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4255249460 0 11 30 6❑ LAST NAME SARMIENTOS GOMEZ FIRST NAME ADRIAN MIDDLE N 1 1 2 31 INITIAL STREET ❑✓ 566 BRONSON WAY NE CITY RENTON ST WA 71p 98057 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID -O B 07 1- 08 - 2001 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� CL Y4938 sTArr WAurN# KNDJT2A56C7468473 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 3 2012 KIA SOUL SD DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO ADRIAN SARMIEN117 W CASINO RD APTA2 EVERETT WA 98204 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LABILINICTY INSURANCE z INSURANCE CO BRISTOL WEST 601507965700 3 4 IN I EFFECT POLICY# STOP VELE 5 36 LEGALLY res❑NO❑ CITATION# CHARGE 1 o BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:3604813646 16 a LAST NAME LE FIRST NAME CELESTINE MIDDLE M INITIAL 17❑ NEW STREETREs7 1670 SKYLINE RIDGE LN SW CITY TUMWATER ST WA ZIP 985121442 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YES❑No� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DRIVER'S STATE WA ]SEX IF D.O.B. 03 _ 22 _ 2003 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS I AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑LICENSE I 21❑ PLA E# CLC1205 TArE WA VIN1i JTEAAAAH3RJ157603 41 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2024 MAKE TOYT MODEL VENZA STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO BINHSON LE 1670 SKYLINE RIDGE LN SW TUMWATER WA 98512 VEHICLE NO.2 SHADE DAGED AREA 4 LIABILITY INSURANCE I PORGY#E CO GEIC04424-29-31-67IN 1 5 vewcLe ❑ ,J� CITATION# CHARGE 25 GQ LEGALLY YES N`L J s � e =TURNER NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12650 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF28551 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11014 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. JASON TURNER 10-24-24 11:23 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1012512024 7:44:16 PM BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED 7:28 Pry TIME POLICE ARRIVED',7:35 PM PART I PAGE IT]OF 4� REPORT NO. EF28551 CASE# 24-11014 OF COLLISION 10/22/24 19:28 OF CbLLI510N NARRATIVE Unit 2 was traveling in the #1 westbound lane on NE Sunset BLVD approaching the intersection of Edmonds Ave NE and Sunset BLVD NE. Unit 1 was traveling in the #2 westbound lane on NE Sunset BLVD approaching the intersection of Edmonds Ave NE. Just prior to the intersection Unit 1 put on their left blinker and began to merge left into the #1 lane. Unit 1 struck the front passenger side of Unit 2's vehicle while changing lanes. Unit 2 had significant damage to the passenger side of their vehicle, the passenger side door was dented and the passenger side tire was flat. Unit 2 required a tow to move their vehicle. Unit 2 reported no injuries. Unit 1 had significant damage to the front driver's side of the vehicle as well as the front bumper. The front driver's side axle was broken and required a tow. Unit 1 reported no injuries. I assisted both parties in exchanging information. I find that the proximate cause of the collision was Unit 1's failure to change lanes when safe. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by J. Turner 12650 on 10/24/2024 at 2310 hours. PAGE 3 OF 4 REPORT NO. EF28551 CASE# ' 24-11014 DATE AND TIME 10/22/24 19:28 OF COLLISION .Y iYaY. 7 Y r, Y a ' PAGE 4 OF 4