HomeMy WebLinkAbout25-2217 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF74184oc� RA
; COL-'J'®N RERT 1591971
❑ FIRE I
CASE 2$-2217 2 0 7
INTERSTATE CITY STREET ✓ RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LDCAI-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#
DATE OF N E IN eDLLISION' 03 - 11 - 2025 1811 17 =.= S 8 W❑ OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 12TH ST BLOCK NO. e 4100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES�.� FEET e S 8 W e UNIONAVENE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4252005342 0 8 30
6 LAST NAME GIL GONZALEZ FIRST NAME GUILLERMO MIDDLE N 1 1 2 31
INITIAL
STREET ] 602 29TH ST SE TRLR 86 CITY;AUBURN ST WA I ZIP 1 980027782 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ✓NC INTERLOCKYEs,/ NO YES NL r,/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' O6 - 27 - 1996 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 1
NATURE of INJURIES 2❑
LICENSE, CBT3169 STATE WA VIN#; 1HGCR2F15HA240635 3
10 F PI ATP tt
TRAILER TRAILER
11 2 5❑ STATE STATE ROM To
PLATE# PLATE#
TRLR TRLR 7 3 33
12 Q 0 VIN#' VIN#
FROM TO
VEH.YEAR 2017 MAKE HOND MODEL ACCOR STYLE SD VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34
13 DAMAGE YES ✓ YES NO✓
REGISTERED OWNER INFO GUILLERMO GIL GONZALEZ 1190 UNION AVE NE APT D5 RENTONWA98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE 4
IN EFFECT &POLICY# 9TOP _
srnNowc ❑ ❑ 5AO115832 CHARGE OP MOT VEH W/OUT INSURANCE t a oorrob z 36
Yes NO CITATION#
15❑
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT O2 VEHICLE CYCLE nWNFR YES NO �/ D:2064683512
16�
LAST NAME WAMBUI FIRST NAME ERIC MIDDLE M
INITIAL
17 F1 STREET ❑❑ 23705 101 ST PL SE APT C302 CITY KENT ST, WA ZIP 980314275 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYES No✓ INTERLOCI£YES NO✓ YEs NO✓
19❑ DRIVER'S STATE WA SEX M D.O.e. 11 29 1973 � 39
LICENSE# MMDDYY -
:
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS I1 ❑
21 LICENSE BXC5923 TATe WA VIN# 1HGCM664X7A073221 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2007 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN
TOWED GOV HI 44
24❑ DAMAGE YES NO✓ BY
VES NO✓
REGISTERED OWNER INFO ERIC WAMBUI 166056TH AVE WART G207 LYNNWOOD WA 98037 VEHICLE NO.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCE CO AMER FAM 41074-69068-89
IN EFFECT &POLICY# I STOP
HICL
L'—L YES N CL] CITATION# CHARGE to BOTTOM
VEE
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
❑
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF74184
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2217
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 GLASS 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
Unit 2 stopped on NE 12th St at the stop sign/intersection with Union Av NE, facing eastbound. Unit 1
traveling eastbound on NE 12th St approaching Union Av NE. Unit 1 driver admits to falling
asleep/fatigue and rear ends Unit 2 causing reportable non disabling front end damage to Unit 1 and
non reportable non disabling rear end damage to Unit 2. No injuries. Unit 1 driver driving status per
WA DOL at the time of collision was DWLS/R 3rd. Unit 1 without proof of valid vehicle insurance. Unit
1 driver cited for no insurance and was the promixate cause of the minor collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 03-11-25 06:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 3/15/2025 7:26:28 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:13 PM TIME POLICE ARRIVED i 6:17 PM
PAST B a Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EF74184 CASE# 25-2217 DATE AND TIME 03/11/2518:11
OF COLLISION
Y
��
K,4K i
Y }
n�Y'
'
}
t
4=
t
;1
K
3 w}�
5
hAK
I
pz�49
31
}0
d.,
Ni
PAGE 3 OF 3