HomeMy WebLinkAbout24-12682 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
SASE 24-12682 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 12 - 10 - 2024 2110 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
EDMONDS AVE NE BLOCK NO. e✓ 400
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:3863658702 1 4 30
6� LAST NAME BEARDSLEY FIRSTNAME CHRISTOPHER MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 204 NW EMPOR/A GLN CITY LAKE CITY ST FL 2jp, 32055 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 H U SE CLA SY 1 NATURE OF INJURIES z❑
3
10 P1 ATNES# Y75MEW sTATe FL v N# 3N10E2CPXFL440745
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
2015 NISS VERSA 5D plsA FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 4 DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO DEBBIE GONZALEZ 2540 SE APPLEBY ST PTSTLUCIEFL34984 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCE CO GEICO 4447928393
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,DIING 7 6
UNIT VEHIMOTCCLE CYCLE Z PEDAL- ❑ PEDESTRIAN ❑ OWN ARTY [:]EA.
✓ NO OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LLIICENS RIVEWS# STATE SEX U MMDDYY 39
WELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
LICENSE ❑21❑ PLA E# CFV2605 TATe 41
WA VIN# WBANV13529C155257 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2009 MAKE BMW/ MODEL 528 STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO MICHELLI SPILMANN464 EDMONDS AVE NE RENTON WA 98056 D:4257367603 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 526 8970-D18-47IN 1 STOP 5
"'LE ❑ N`LJ
,.I— CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
RYAN KARLO RIVERA 1
12649 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF45413
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12682
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
POS. 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.
RYAN KARLO RIVERA 12-11-24 12:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1211312024 12:59:50 AM
BADGE OR ID# 12649 ORI# WA0171300 TIME POLICE DISPATCHED 9:97 Pry TIME POLICE ARRIVED',9:20 PM
PART I PAGE IT]OF
REPORT NO. EF45413 CASE# 24-12682 OF COLLISION
12/10/24 21:10
OF CbLLI510N
NARRATIVE
On 12/10/2024, 1 was working uniformed patrol in a marked police car as 3R23. At approximately
2117 hours, I was dispatched to a non-injury, non-blocking accident at 464 Edmonds Ave NE, which
is located within the city limits of Renton, County of King, Washington. Dispatch advised that the
caller reported that a vehicle was involved in a collision with 2 parked cars.
When I arrived at the dispatch location, I was able to locate all involved parties and vehicles. They are
listed and identified as Unit 1, Unit 2, and Unit 3 respectively.
I was able to speak to the driver of Unit 1. My conversation with him is summarized as follows:
Unit 1 stated he was traveling northbound on Edmonds Ave NE. Unit 1 mentioned that as he traveled
northbound on Edmonds Ave NE, he noticed that an unknown white sedan had pulled out on his left
(Windsor Way NE) into the middle of Edmonds Ave NE in the direction where his vehicle was driving.
To prevent colliding with this unknown white sedan, Unit 1 swerved to the right and hit 2 parked and
unoccupied cars on the side of the road.
Unit 1 believed the unknown white sedan was possibly a white Cadillac. Unit 1 was unable to provide
me with any other information.
The unknown white sedan did not strike Unit 1.
I took a look around Unit 1 and saw that there was significant damage around the front and
passenger sides of the vehicle. Some large dents and scratches ran along the front and passenger
side of the vehicle. I also saw that the airbags in his vehicle were deployed.
The driver of Unit 1 stated he was not injured and declined aid at the scene.
The owners of Unit 2 and Unit 3 also came out to speak with me. They were able to provide me with
documentation and insurance for their respective vehicles.
I looked around Unit 2 and saw that there was damage to the rear driver's side wheel well and door
area. The driver's side rear wheel was overturned and there were deep scratches that ran along the
rear driver's side bumper area and door panel.
Unit 2 was unoccupied at the time of the collision.
I looked around Unit 3 and saw that there was damage to the entire driver's side door area. The
driver's side door panels had deep scratches that ran along the entire side of the car.
Unit 3 was unoccupied at the time of the collision.
Other officers at the scene mentioned that the occupants of 464 Edmonds Ave NE had surveillance
but it did not catch anything identifiable. The owners of Unit 2 and Unit 3 were associated with this
address.
I provided an exchange of information to all involved parties.
Gene Meyers took possession of Unit 1 as it was undriveable.
Other officers at the location gave the driver of Unit 1 a ride back to his apartment nearby.
PAGE 3 OF 6
REPORT NO. EF45413 CASE# 24-12682 OF COLLISION
12/10/24 21:10
OF CbLLI510N
NARRATIVE
The owners of Unit 2 and Unit 3 returned to the dispatch address.
This report is for informational purposes only to document the incident.
This concludes my report.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct
Signed: Ryan Rivera (#12649) Date & Place: 12/11/2024 @ Renton, Washington
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. EF45413
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-12682
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR
PEDAL-
5 ❑ AL � PROPERTY � YD � OLDMET PHONE# 3 VEHICLE CYCL PEDESTRIAN OW G
1 4 29
LAST NAME : UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET 30
NEW Ann2FS CITY RENTON ST ZIP
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES No zERLOCK YES❑N0� YES N
DRIVER'S STATE I SEX U M��DVSYv' -� 2
LICENSE
7
ON DUTY STATUS AIRBAG 9 RESTR. g EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES
F�
USE CLASS
8 ❑ 1 32
LICENSE I CNP8Y89 [TAT WA VIN# 3FA6POSU7LR264767
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 O O VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1G P FROM TO
2020 FORD FUSION SD DAMAGE YES NO YES NO
REGISTERED OWNER INFOJHONI DOS SANTOS DA SILVA 2307 NE 4TH ST#D301 RENTON WA 98056 D:2065325022 SHADE IN DAMAGED AREA
m 33
12
7 j 4 FROM TO
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# t 9 101?
VEHICLE 1 o BarroM 34
❑ ❑ CITATION# CHARGE C
13 LEG LEY
YES NO
STANDING }
14 ❑ UNIT Tr Vd 1 RE O CYDDAL 1:1PROPERTY YES AGE NOHRESHOLD MET PHONE 35
PEDESTRIAN
11
15 LAST NAME FIRST NAME MDDLE INITIAL36
STREETITIAL
❑
16 NEW AnnRFs� CITY: ST ZIP
CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑
17 5 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE rnr vIN#
PLATE#
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ [441
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VEHICLE
EFFECT &POLICY# I 970P - 4 44
24 LEwcLE YES NO❑ CITATION# CHARGE iq 60TiOM
E:l
C=DLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
RYAN KARLO RIVERA 12-11-24 12:04 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12649 O#II,WA0171300 APPROVED BY
12113/202 PAGE OF 6
3000-345-013(R 11118)
REPORT NO. EF45413 CASE# 24-12682 DATE AND TIME 12/10/24 21:10
OF COLLISION
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PAGE 6 OF 6