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HomeMy WebLinkAbout24-11905 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET ❑ FIRE ❑ CASE#r` 24-11905 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4'I00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ RESERVATION STRUCK 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION.. 11 - 1-- 2024 2315 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 4621 NE SUNSET BLVD BLOCK NO. e✓ --- ----� 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2065301288 0 11 30 6❑ LAST NAME FERGUSON FIRSTNAME DANIEL MIDDLE L 1 1 2 31 INITIAL STREET ❑, TRANSIENT CITY RENTON ST WA Zjp, 98059 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID -O B 10 1— 18 — 1982 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES 2❑ 3 ,OF PI ATE 14 BBN3307 sTAT WA V N# TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 0 0 VIN If VIN# FROM TO VEH.YEAR ZOO9 MAKE TOYT MODEL SCION STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 DAMAGE YES NO YES❑ NO 13❑ REGISTERED OWNER INFO DANIELFERGUSONTRANSIENTRENTONWA98059 D:2065301288 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA ❑ 35 14 UABILI INSURANCE❑ INSURANCE CO NONE 3 4 IN EFFECT &POLICY# VEHICLE 5 36 LEGALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064689633 16 2 LAST NAME GARCIA-SILVA FIRST NAME HECTOR MIDDLE J INITIAL 17❑ STREET ❑', 1555 ANACORTES AVE NE, C212 CITY RENTON ST WA ZIP 98059 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 DRIVER'S STATE WA SEX M D.O.B. 07 15 _ 1984 39 LICENSE# MMDDYY WELMET INJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ 21❑ LICENSE E9687443 TATe WA VIN# 1G1PC5SB5D7320048 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2013 MAKE CHEV MODEL CRUZE STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO HECTOR GARCIA-SILVA 1555 ANACORTES AVE NE,C212 RENTON WA 98059 D:2064689633 VEHICLE NO.2 SHADE IN DA GEbAREA z Cdd LIABILITY INSURANCE &POINSURGY#E CO NATIONAL GEN 202536812IN 1 9TOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N`LJ 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 N.ODALOV/C 11628 WA0171300 PAGE 01 OF PART A 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF36480 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11905 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RAMIREZ-MENDEZ SANDRA (LAST FIRST, ADDRESS&PHONE# D O.B. 1555 ANACORTES AVE NE,C212 RENTON WA 98059 SEX F MMDDYyry 11 - 02 - 1989 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS❑;UNIT# 2 POS 3 AIRBAG;2 RESTR. 9 EJECT 1 USE CLASS I6 COMPLAINT OF BACK PAIN NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX' MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY POS. NATURE OF INJURIES 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' 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. N.ODALOV/C 11-17-24 12:51 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 1111712024 8:06:29 PM BADGE OR ID# 11628 ORI# WA0171300 TIME POLICE DISPATCHED 11:15 PM TIME POLICE ARRIVED',11:31 PM PART I PAGE IT]OF 4� REPORT NO. EF36480 CASE# 24-11905 OF COLLISION 11/16/24 23:15 OF CbLLI510N NARRATIVE 24-11905 Unit 1 -WA Lic/BBN3307 maroon 2009 Toyota/Scion XB Driver/registered owner of unit 1 -Daniel L Ferguson (DOB 10-18-1982) Unit 2 -WA Lic/E9687443 (dealer plate) VIN/1 G1 PC5SB5D7320048 white 2013 Chevrolet Cruze Driver/registered owner of unit 2 -Hector J Garcia-Silva (DOB 07-15-1984) Front passenger-Sandra Ramirez-Mendez (DOB 11-02-1989) Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 11-16-2024 at approximately 2322 hours I was dispatched to a collision that occurred in the private parking lot just north of Albertsons (4621 NE Sunset Blvd). I arrived at approximately 2331 hours and contacted all involved parties. Daniel stated he is currently homeless and sleeps in this parking lot. He was driving through the lot eastbound just south of El Rinconsito. Daniel stated the other vehicle was driving south through the parking lot just east of El Rinconsito. I spoke to Hector utilizing Language Line Solutions for Spanish. Hector had the same story as Daniel and stated he was driving to the store. There are no stop signs in that section of the parking lot. It is unclear who would have had the right-of -way for travel at the time of the collision. No airbags were deployed, and both units were drivable. Sandra, Hector's passenger, complained of back pain from the collision and declined to be evaluated by the Renton Fire Authority for injury. There is damage to the front side of unit 1 and there is passenger side damage to unit 2 consistent with the information I was told about the incident. Hector provided insurance information. Daniel stated he did not currently have insurance. Daniel was given a verbal warning for not having valid insurance. I photographed the Chevrolet which was uploaded to evidence.com. 1 failed to photograph the Toyota before my departure, but observed scrapes to the front end of the vehicle and this was also captured on my body-worn camera. During this incident I was equipped with body-worn camera which records both audio and video. Portions of the incident were recorded. This report is merely a summary of the incident and is not intended to be an exact transcription of the entire investigation or what may have been captured with the recording system. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by N. Odalovic#11628 on 11-17-2024 at 0030 hours in Renton, WA. PAGE 3 OF 4 REPORT NO. EF36480 CASE# ' 24-11905 DATE AND TIME 11/16/24 23:15 OF COLLISION a�x t i x t � r tt�fi 4t 31�Fr 944 �s c� u x yY oW &A PAGE 4 OF 4