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HomeMy WebLinkAbout24-11871 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-11871 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 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 11 - 1-- 2024 1608 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ 108TH AVE SE BLOCK NO. e✓ 10800 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ V\l e SE PETROVITSKYRD 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El No ,/ I D:2538864258 0 11 30 6❑ LAST NAME RAZZAQ FIRSTNAME UMER MIDDLE 1 2 31 INITIAL STREET ❑ 11718 SE 239TH PL CITY KENT ST I WA 2jp, 98031 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO 8❑ LDRIVER # STATE WA SEX'M MID LOB 08 1- 20 - 1989 2 32 9 ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� CKX4642 sTATI WAurN# 2GNAXKEV5M6103578 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR 2021 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 4 CHEV EQU/NO UT DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO GIECO 6163338335 3 4 IN EFFECT &POLICY# 9TOP 15❑ vECEHA"LE 5 36 LLLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2064995090 16 2 LAST NAME CACERES REYES FIRST NAME MARIA MIDDLE D INITIAL 17 NEW STREETR 7' 14752 SE 187TH CT CITY' RENTON ST WA ZIP 98058 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑ 19 D IVERI # ❑ ON DUTY STATUS AIRBAG, 1 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES ❑ 40 USE CLASS WHIPLASH ❑ILICENSE 21❑ PLA E# BYG8999 TATE 41 WA VIN# KM8K1CAA7MU729105 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2021 MAKE HYUN MODEL KONA STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,� YES NO REGISTERED OWNER INFO DANILO CACERES 14752 SE 187TH CT RENTON WA 98058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO PROGRESSIVE 930967788IN I STOP VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N`LJ 25 s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEITH PETTY 12809 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38219 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11871 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES PM USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R 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. KEITH PETTY 11-15-24 08:23 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.TRADER 4553 11/21/2024 9:02:17 PM BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED! 4:14 PM TIME POLICE ARRIVED',4:19 PM PART I PAGE IT]OF 4� REPORT NO. EF38219 CASE# 24-11871 OF COLLISION 11/15/24 16:08 OF CbLLI510N NARRATIVE 24-11871 On 11/15/2024 at approximately 1614 hours I was working for the city of Renton as a police officer. I was dispatched to the intersection of SE Petrovitsky Rd and 108th Ave SE in the City of Renton County of King State of Washington for vehicle collision. Upon arrival I contacted Maria D J Caceres Ryes (DOB 08/15/1972) identified by her WADL photo. Maria was the V2 driver of a gray 2021 Hyundai Kona (BYG8999/WA) VIN/KM8K1CAA7MU729105. The V1 driver of the 2021 Chevy Equinox (CKX4642/WA) VIN 2GNAXKEV5M6103578, identified as Umer Razzaq (DOB 08/20/1989) through his WADL photo he left with the V2 driver. Maria stated that as she was waiting at the light in lane 1 the V1 driver had collided into the back of her car. They exchanged information and the V1 driver left before I arrived. Maria had given me the drivers info. No damage was apparent on the V2 vehicle. Maria stated that she was feeling a little dizzy and was going to seek medical attention. I asked if she wanted me to call RRFA to the scene, but she refused. This incident was captured on my body worn camera. This report is a summary of the events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct." Electronically signed: K.Petty, Date: 11/15/24 at 2007 hours, Place: Renton, King County, WA PAGE 3 OF 4 REPORT NO. EF38219 CASE# ' 24-11871 DATE AND TIME 11/155/24 16:08 OF COLLISION ` �M1 r 1 4 5 F w 7 t t+ j S. `m s t £ Y Y4 i c � £ £ £ ;zit t � l 3 sti s 61, � x 4 � d �� ll PAGE 4 OF 4