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HomeMy WebLinkAbout25-1458 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF66267oc� RA COLLISION REPORT 1591971 CASE# 25-1458 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCAI-AGENCY 4150 3 C©DING COUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 7 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s on' 02 - 14 - 2025 1735 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE SUNSET BLVD BLOCK ST e 4a MILE POST 4100 .� ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------ 1.1 FEET e S 8 W e UNION AV NE 0 8 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4255182918 0 1 30 6 LAST NAME MARTINEZ MICAELO FIRST NAME JAIME MIDDLE t 1 2 31 INITIAL STREET ] 1555 ANACORTES AVE NE APT F12 CITY; RENTON ST WA ZIP; 980593987 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs Na✓ INTERLOCKYEe Nb✓ YES D NO✓ 8 DCIENSE# STATE WA SEXI M MMDDYY' 08 — 04 — 1975 1 2 32 T [NATURE OF 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT, 1 HELMET U E LA SS 7 BACK PAIN JURIES 2 10 1� LI ENSE', BLC3155 STATE WA VIN# 5NIANONW5FN662022 3 TRAILER 11 3 5 STATE TRAILER STATE ROM To PLATE# PLATE# TRLR zRLR 9 9 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 2015 MAKE NISS MODEL XTERRA STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 3 7 34 13� DAMAGE YES II_II NO ✓ YESII_I) NO REGISTERED OWNER INFO JAIME MARTINEZ MICAELO 1155 ANACORTES AVE NE APT FI2 RENTON WA 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 2 3 14 AMERICAN FAM MUT 410 77-7330 1-71 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE t 36 Lemur yes�NO❑ CITATION# 7 0 80TTOM 15❑ sTANowc s 7 UNIT 02 MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE CYCLE nWNRR 16� LAST NAME UNKNOWN FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY, RENTON ST ZIP ❑ 37 NEW ADDRESS 1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 CDL INTERLOCKYEs No✓ INTERLOCK YESEl Nd✓ vEs NO✓ 19 DRIVERS # STATE SEX U MMDDYY —= � 39 HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG g RESTR g EJECT 1 USE 9 CLASS 0 ❑ 21 PLATE# UNK TATE VIN# UNKLICENSE I El 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR MAKE MAID MODEL UNK STYLE $V VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &.POLICY# 9TOP YemcLE ❑ ,.I—I CITATION# CHARGE to BOTTOM EEGAEEY YES NC 25 s s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF66267 COLLISION REPORT III III III III III 111 1591972 CASE# 25-1458 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES POS. ' USE GLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CIASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Unit 1 driver reported that he was the victim of a hit and run collision at the intersection of NE Sunset Blvd and Union Av NE. Unit 1 reported that he was stopped, westbound at the light at said intersection. Unit 1 stated he was struck from behind by Unit 2 causing non reportable non disabling rear end damage to Unit 1 and unknown damage to the front of Unit 2. Unit 1 driver reported complaint of back pain. Unit 1 driver stated that Unit 2 sped off to which he gave brief chase before losing sight of the vehicle near NE Sunset Blvd and NE 10th St. Unit 1 driver assessed on scene by Renton Fire for back pain. Unit 2 and Unit 2 driver remain unidentified. Unit 1 driver unable to provide description of Unit 2 driver, or vehicle plate. No witnesses. No actionable leads at this time. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 02-14-25 08:55 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVEQ BY DATE JAKE GALL 12617 211612025 6:55:06 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:37 PM TIME POLICE ARRIVED i 5:42 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EF66267 CASE# 25-1458 DATE AND TIME 02/14/2517:35 OF COLLISION Cc Jkl- e ix 1 t 4{ Sa xd u tbkTMfi S�srt `, PAGE 3 OF 3