HomeMy WebLinkAbout25-2566 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF75778oc� RA
COLLISION REPORT 1591971
CASE# 25-2566 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 03 - 21 - 2025 1155 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK NO.
4a❑
MILE POST e
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 5001.1 00-] MILES N
FEET e✓ S 8 E e LAKE AVE S
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4157184871 0 1 30
LAST NAME MATH HERNANDEZ FIRST NAME ANTHONY ROSNEY MIDDLE q
5 INITIAL 1 2 31
STREET ❑ 8340 RAINIER AVE S UNIT 101 CITY; SEATTLE ST I WA ZIP; 98118 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO✓ INTERLOCK YEs No✓ YEs NO�/
8❑ ENSE# STATE SEX I M MMDDYY' 09 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET 2 CLASSY 1 NATURE OF INJURIES 2
10 LI ENSE'' 9DTC192 STATE CA V rN# JTDKN3DU2C5426207 3
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# 11ROM To
TRLR zRLR. 3 5 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR 2012 MAKE TOYT MODEL pRIUS STYLE 4H VEHICLE TOWED[n TO ZBUN TOWEDBY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO DANIELLE ACOYLE CAMPOS 136 MISSION DR PLEASANTON CA 94566 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 NSURANCE CO 3 4
14 ABILITY INSURANCE CSAA CAAS225507831
IN EFFECT &POLICY# i 4TOP 5
VEnicLE CHARGE 7 0 60TTOM 36
15
Lrn Lyc YES❑NO❑ CITATION# 5A0374317,5AO374318 PROHAMPROPER TURN,NO VALID s
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:2535083270
16�
LAST NAME MILLER FIRST NAME RICHARD MIDDLE A
17 STREET
INITIAL
❑
439 RENTON AVE S CITY RENTON ST, WA ZIP 98057
4 37
NEW ADDRESS❑
1g� IGNITION REQUIRED IGNITION PRESENT MEDfCAL TRANSPt7RTED. 38
CDL INTERLOCKvEs ND✓ GNTERLOCK YES xz ✓ YEs NO'✓
19 DRIVER'S STATE WA SEX M D.O.B. 02 01 1982 39
LICENSE# MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSLATE E FCO2637 TATE WA VIN# 5UXCR6C04L9C96031 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE BMW MODEL XS STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO RICHARD MILLER 439 RENTON AVE S RENTONWA98057 D:2535083270 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE 807721879
IN EFFECT &POLICY#Y 1—LEGALLY YES❑ N,J—I CITATION# CHARGE UR
`,LI25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
J.TRADER 4553 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF75778
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2566
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE IINITIAL) SANTANA MUNOZ GEISSE J
ADDRESS&PHONE# D�
8340 RAINIER AVE S UNIT 101 SEATTLE WA 98118 4157569737 SEXi M MMDDYYYY B. 09 — 28 — 1986
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 3 2 4 1 USE 2 CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
25-2566
On 03-21-2025 at approximately 1155 hours, Unit Two was traveling WB in the number one curb lane
in the 200 block of S 2nd ST, in the City of Renton, County of King. Unit One was traveling WB on S
2nd ST in the number two lane slightly ahead of Unit Two. Unit One made a left turn into a business
driveway. Unit One turn in front of Unit Two and was the proximate cause of the collision. Unit Two
has a fair amount of front-end damage. Unit One had damage to the driver side rear quarter section
of his vehicle.
There were no injuries, and all occupants of the involved vehicles were wearing their seatbelts. The
vehicles were drivable.
The driver of Unit One was identified with a Venezuelan ID as Mata Hernandez. Mata Hernandez did
not have a valid license. The owner of the vehicle provided their insurance company name and policy
number by phone. Officer Raygoza assisted at the scene with translation since Mata Hernandez
primary language is Spanish. Mata Hernandez was informed he would be receiving citations via mail
for the violations he committed today.
I gave both drivers a business card with the case number on it to report to their insurance. Violations
cited NVOL Wo/ID and Unsafe Lane Change or Turn.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 03-21-25 02:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 312112025 2:15:07 PM
BADGE OR ID# 4553 ORI# WA0171300 TIME POLICE DISPATCHED 11:55 AM TIME POLICE ARRIVED i 11:55 AM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. E F75778 CASE# 25-2566 DATE AND TIME 03/21/25 11:55
OF COLLISION
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