HomeMy WebLinkAbout25-2333 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF7418OLCERA
COLLISION REPORT 1591971
CASE# 25-2333 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCODIOENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
TRIBAL UNITS 01 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 03 - 14 - 2025 2335 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE SUNSET BLVD BLOCK ST e 3700 .=
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 2001.1 00 FEET e✓ S 8 W e QUEEN AV NE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4257289117 30
5 LAST NAME SANTANA FIRST NAME ANDREW MIDDLE I N 1 0 4 31
INITIAL
STREET ❑ 950 HARRINGTON AVE NE APT S50 CITY; RENTON ST WA ZIP; 980563485 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO,/ INTERLOCKYEs No�/ YEs NO,/
8❑ DRIVERCENSS# STATE WA SEXI M MMDD YY' 10 - 21 - 1998 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE of INJURIES 2
USE CLASS COMPLAINT HEAD/NECK PAIN
10 PI ENS AUS8834 STATE WA VIN#, 19UUA76527AO46414 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR TRLR 7 3 33
12� UIN#' VIN#
: FROM TO
VEH.YEAR 2007 MAKE ACUR MODEL TL STYLE 4D VEHICLE TOWED fn TO ZBUN TOWEDBv GOVT VEHICLE m 34
13 DAMAGE YES II_II NO YESIE] NO
REGISTERED OWNER INFO ANDREW SANTANA 2120 NE 18TH ST RENTON WA 98056 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE / INSURANCE CO GE/CO 6185651855 3OIN
EFFECT &POLICY#VEn" CHARGE 36
Lemur yes❑NO❑ CITATION# t a 6
15❑ nNowc
.
1:1PROPERTY DMTHR OLD MET PHONEPEDAL-: PEDESTRIAN YE NOUNIT U2VMEOHTIOCRLE CYCLE OWNER
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET CITY ST ZIP ❑ 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38
INTERLOCKYEs NO INTERLOCK YES R No vEs NQ
19 LICENS# STATE SEX MMDCSYY —� 39
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASSLICENSE
❑
21 PLATE# VIN# 41
TATE
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. '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 CO
IN EFFECT &POLICY# 9TOP
vewae ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEy YES N`0
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF74185
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2333
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 CLASS ----�
: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
Single vehicle collision. Unit 1 driver reported traveling eastbound along the 3700 block of NE Sunset
Blvd. Unit 1 driver reported that unknown black Mercedes sedan swerved into his right lane of travel
which caused Unit 1 to career and crash into the sidewalk, ditch running parallel with NE Sunset Blvd.
Unit 1 sustains heavy reportable disabling damage to the front as well as to both front tires and to the
rear driver side tire/possible axle damage. Unit 1 driver complaint of neck and head pain but declined
aid on scene. Unit 1 remained parked within lot at 4033 NE Sunset Blvd awaiting private tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 03-15-25 12:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 311512025 7:26:20 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 11:42 PM TIME POLICE ARRIVED 11:49 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EF74185 CASE# 25-2333 DATE AND TIME 03/14/25 23:35
OF COLLISION
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