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HomeMy WebLinkAbout24-6921 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 SASE 24-6921 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 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 07 - 1-- 2024 0943 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ ABERDEEN AVE NE BLOCK NO. e✓ 1600 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ e S ❑❑ FEET VV e NE 16TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4253512453 0 11 30 6� LAST NAME MORALES-AREVALO FIRSTNAME HUGO MIDDLE E 1 2 31 INITIAL STREET ❑ 10217102ND AVE CT SW CITY LAKEWOOD ST WA ZIP 98488 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES No 8❑ DRIVERS # STATE WA SEXI M I D-MIDI Y' 08 - O6 - 2000 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10 2❑ P1 ATNES# C04055T sTAr WAu N# 5TFDY5F11JX683911 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 2 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR 2018 TOYT TUNDR PK D MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 13 34 4 AMA GE YES NO YES[:] NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO AMFAM 41003-41092.38 4 LI EFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLYYEs NO CITATION# 4AO196795 INATTENTIVE DRIVING <1�3 orrom 15❑ STANDING 7 6 MOTOR PEDAL- ❑ .PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE' ❑ OWNER ❑ YES 1/ NO DD 4252712279 16 a LAST NAME LUKOWSKI FIRST NAME DAVID MIDDLE IG INITIAL 17❑ STREET ❑', 1164 CAMAS AVE NE CITY RENTON ST WA ZIP 98056 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑ 19[—] D IVEW # I INJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE B79298P TAre WA VIN1 1GCCS19X638124275 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2003 MAKE CHEV MODEL STRUCK STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO DAVID LUKOWSKI 1164 CAMAS AVE NE RENTON WA 98056 D:4252712279 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE I PORGY#E CO AMFAMBX01541052IN IURVE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.JACOBS 1953 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF11726 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6921 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MORALES-ANAYA K►MBERLYA (LAST FIRST, ADDRESS&PHONE# LAKEWOOD SEX' F MMDDYYYY 08 - 06 - 2002 --------------------------- PASSENGER Z WITNESS UNIT# 1 SEA 3 AIRBAG 2 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES USE CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On 7-2-24 at about 0959 1 arrived at the intersection of NE 16th and Aberdeen Ave NE for a 2-vehicle collision. I contacted all occupants of the vehicles in or near their vehicles. Both drivers were identified via WADL. Driver 1, Hugo Morales told me; He was not paying attention when he pulled into the intersection and collided with unit 2. He nor his passenger was injured. Driver 2 told me; He stopped at the stop sign. As he was pulling away from the stop sign, unit 1 failed to stop and collided with his vehicle. `He was not injured. I cited Hugo for inattentive driving via complaint. Both vehicles were released to the respective drivers. This incident occurred in the city of Renton, County of King. I declare under penalty of perjury under Washington state law that the foregoing is true and correct. C. Jacobs/1953 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.JACOBS 09-02-24 10:41 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 9/4/2024 3:56:34 PM BADGE OR ID# 1953 ORI#', WA0171300 TIME POLICE DISPATCHED 9:46 AM TIME POLICE ARRIVED',9:59 AM PART I PAGE IT]OF REPORT NO. ER 1726 CASE# 24-6921 DATE AND TIME 07/02/24 09:43 OF COLLISION .`1 Not drawn to scale Aberdeen Ave N r, PAGE 3 OF 3