HomeMy WebLinkAbout25-1065 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-1065 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� TOTAL#OF OBJECT 1 �2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 02 - 1-- 2025 0130 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 3600
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FMILES EET e S ❑ E e REDMOND PL NE
0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
LAST NAME ZAVALETA VILLAGOMEZ FIRST NAME ANGEL MIDDLE D
6 INITIAL 1 2 31
STREET ❑ 1509 UNION AVE NE CITY RENTON ST WA 2jp, 980593905 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NOZINTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 10 - 09 - 2004 32
9 ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ Pi ATNES# CMA6009 sTAr WAv N# 19XF62F50DE218066
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
FROM
34
13� VEH.YEAR2013 MAKE yOND MODEL CIVIC STYLE SD VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYER vOs❑ENo�
HICLE
DAMAGE IILLJJII (��IV6
REGISTERED OWNER INFO ANGEL ZAVALETA VILLAGOMEZ 1509 UNIONAVE NE RENTON WA 98059 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NONE
IN EFFECT POLICY&POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLY YES❑NO CITATION# 5A0115828 OP MOT VEH W/OUT INSURANCE, )o eorrom
15❑ STAIN.D" 8 6
UNIT 02 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLEITIAL
IN
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 LLIICENS # STATE SEX MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE vIN# 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ"'LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12651 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EF63656
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1065
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'
Single vehicle collision. Unit 1 traveling eastbound along 3600 block of NE Sunset Blvd. Unit 1 loses
control due to excessive speed while driving in icy and snowy road conditions just to the east of
Queen Av NE and careers into electrical/transformer box on the south side of the roadway adjacent to
the sidewalk. Unit 1 rotates and comes to a sliding stop 180 degrees and sustained heavy reportable
disabling damage to the passenger side undercarriage and passenger side tires, possible rear axle
damage. No injuries reported. Unit 1 driver was positively identified via his WA DOL photo, admitted
to driving on scene, and admitted to having no vehicle insurance. It was undetermined property
ownership of the electrical box due to complete lack of markings. Unit 1 driver was the proximate
cause of collision as his excessive speed and loss of control caused said collision. Preliminary speed
and crush calculations placed Unit 1 traveling near or in excess of 45 mph in a 35 mph zone based
on estimated skid marks placing Unit 1 having traveled approximately 250 feet from time of loss of
control to impact of stationary property to final stationary position. Unit 1 driver cited for no vehicle
insurance and speeding too fast for conditions.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 02-05-25 05:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 2/8/2025 4:32:53 AM
BADGE OR ID# ! 12651 ORI# WA0171300 TIME POLICE DISPATCHED` 1:44 AM TIME POLICE ARRIVED 1:49 AM
PART I PAGE IT]OF 3�
REPORT NO. EF63656 CASE# 25-1065 DATE AND TIME 02/03/25 01:30
OF COLLISION
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