HomeMy WebLinkAbout25-1194 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF66454OLCERA
COLLISION REPORT 1591971
CASE# 25-1194 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 02 - 06 - 2025 0806 17 =.= S 8 W e IN OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
NE SUNSET BLVD
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.1 FEET MILES e S 8 N e REDMOND PL NE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2532454903 0 1 30
6 LAST NAME CUBASRUIZ FIRST NAME JUSTYN MIDDLE G 1 1 2 31
INITIAL
STREET ❑ 28-1919 147 AVE NW CITY; EDMONTON ST AB ZIP, T5Y2K3 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKVEs No YES N(
8 DCIENSE# STATE AB SEXI M MMDDYY' O6 — 27 — 2004 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET CLASSY 1 NATURE of INJURIES 2=
LICENSE, CNK1717 STATE WA VIN JHMFA36217SO22216 3
10� PI ATF rt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR TRLR. 5 1 33
12 3 5 VIN# vIN#
FROM TO
13 2 VEH.YEAR2007 MAKE HOND MODEL CIVIC STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LR$ GES❑END i' 3 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO MO/SES VALLE RUIZ 95025200TH ST KENT WA 98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA 11
35
14❑ LIABILITY INSURANCE El
NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOQ
VEnic'E CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# t a BOTTOM
15❑ sTANowc
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:4234320199
16�
LAST NAME SALAS RIVERA FIRST NAME JOSE MIDDLE L
INITIAL
17 F1 STREET ❑❑ 11631 26TH AVE S CITY SEATTLE ST, yyq ZIP 981681209 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: ❑ 38
INTERLOCKYEs No INTERLOCK YES NO YES NO
19 DRIVER'S ' STATE WA SEX,M D-o.e• 10 30 1987 � 39
LICENSE# MMDDYY -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE D97238E TATe WA VIN# JALE5W165K7304401 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2019 MAKE 1$(J MODEL NRR STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO DM OHASHI LANDSCAPE SERVICES 30385 SE HIGH POINT WAY ISSAQUAH WA 98027 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
LVEHICLE
'—LY YES❑ N,J—I CITATION11 CHARGE t080TTOM
LEGALL
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF66454
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1194
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ 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
slv/1 slid ice blk/2 eb
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at the intersection
of NE Sunset Blvd and Redmond PI NE.
I contacted the driver of unit 2 driving a utility truck. He told me the was earthbound in lane 1 when
unit 1 seemed to have just pulled out in front of him, or maybe was sliding in the ice. Either was it
was too late to avoid unit 1 and contact was made. He did not complain of injury. The owner of the
work truck was on scene and told me he believed his truck was operable and if it he would make his
own arraignments for a tow.
I contacted unit 1 ID'd by Alberta Canada DL. A WACIC/DOL check revealed he only had ID in
Washington and I was unable to confirm his Canada ID. He told me he was driving a friends vehicle
northbound on Redmond PI NE and could not get stopped because of the snow and ice, He said he
slid into lane one where he made contact with unit 2. He did not complain of injury and damages
required 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 02-07-25 08:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 211712025 10:36:19 AM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:06 AM TIME POLICE ARRIVED i 8:11 AM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EF66454 CASE# 25-1194 DATE AND TIME 02/06/2508:06
OF COLLISION
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