HomeMy WebLinkAbout24-12030 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-12030 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y50 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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#
COLLISION'. 11 - 1-- 2024 1657 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
116 AVE SE BLOCK NO. e✓ 16400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 164 AVE SE
0 4 29
UNIT MOTOR
VEHICL Z CYCLE ElOYESA✓NOESHOLDMET PHONE 0 11
30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[ PI ATE#
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
rRLR. TRLR. 1 3 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE DODG MODEL RAM STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILITY
INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vewcLe
CHARGE 1 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067715911
16 a
LAST NAME VIZIR FIRST NAME ANNA MIDDLE
INITIAL
17❑ STREET EDOREs6❑' 3000 SE ROYAL HILLS DR#3F CITY' RENTON ST WA ZIP 98058 37
❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO V/
19 LICENSE# STATE WA SEX U MMDDYY 02 _ 14 1987 El 39
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
LICENSE I ❑21❑ PLA E# CHM6689 TATE 41
WA VIN# 3FA6PORUXLR132706 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2020 MAKE FORD MODEL FUSION STYLE QD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SERGIU VIZIR 3000 SE ROYAL HILLS DR RENTON WA 98058 D:2067715911 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO GEICO 6177-34-78-43IN IUR'E""LE
❑ ,J� CITATION# CHARGELEGALLYYES N
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.PAGET 8660 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF38803
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12030
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VIZIR AUGUSTIN
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
3000 SE ROYAL HILLS DR#3F RENTON WA 98058 4254998046 SEX M MMDOYyvv 08 - 01 - 2008
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ] 2 POS. , 3 2 4 1 USE 2 CLASS !1
NAME
(LAST,FIRST,MIDDLE INITIAL) VIZIR ALEXANDRA
ADDRESS&PHONE# D O B
3000 SE ROYAL HILLS DR#3F RENTON WA 98058 2067715911 SEX F MMoouvvv 11 _ 07 _ 2019
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 10 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) VIZIR ANNASTASYA G
AooREss&PHONE# 3000 SE ROYAL HILLS DR#3F RENTON WA 98058 SEX F D•O•B. 03 _ 10 _ 2018
MMDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 1 2 INJURY 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.
C.PAGET 11-20-24 09:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 1112312024 9:52:37 AM
BADGE OR ID# 8660 OR]# WA0171300 TIME POLICE DISPATCHED 5:12 PM TIME POLICE ARRIVED',5:19 PM
PART Ei PAGE IT]OF 4]
REPORT NO. EF38803 CASE# 24-12030 OF COLLISION
11/20/24 16:57
OF CbLLI510N
NARRATIVE
24-12030 Hit and run collision - non injury
Axon:
Axon body cam available
Suspect/suspect vehicle
Blue Dodge Ram pickup
Driver is a Hispanic male, age 35-40 yoa, 6'00, medium with a slight beard. Anna Vizir can recognize
again.
Video:
Anna Vizir obtained video of truck passing from house at 16364 116 AVE SE. This does not show
collision or a plate but shows the truck passing prior to the collision.
Axon Citizen invite sent and received for video.
Narrative:
On 11.20.2024 at 1719 hours, I arrived at a non-blocking, non-injury hit and run collision that
occurred at the intersection of 116 AVE SE and SE 164 ST. This address is within the city limits of
Renton, County of King, WA. The collision occurred at 1657 hours.
When I arrived, I spoke to Anna Vizir DOB/02.14.1987 and son Augustin Vizir DOB/08.01.2008 who
assisted in translating. Anna's primary language is Romanian. Anna was driving a black Ford Fusion
WA/CM6689. Anna provided her photo WADL which is valid, proof of insurance, and a registration.
Augustin was seated in the front passenger seat. Alexandra Gloria Vizir DOB/11.07.2019 was in a
forward-facing seat behind the driver. Annastaysa Grace Vizir DOB/03.10.2018 was in the rear
passenger seat. No one in the car was injured. Damage to Vizir's vehicle is at the front driver's side
front bumper and front quarter panel.
Anna told me that she was northbound on 116 AVE SE when a blue Dodge Ram pickup made a left
turn in front of her, striking her car. Anna did see and can recognize the driver of the pickup, but he
did not stop. This driver fled eastbound.
Anna was able to get video from a neighboring house (listed above). I sent an axon citizen invite for
video.
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 by Officer C. Paget/8660 6:28 PM 11/20/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF38803 CASE# ' 24-12030 DATE AND TIME 11/20/24 16:57
OF COLLISION
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