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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
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PAGE 4 OF 4