HomeMy WebLinkAbout25-2782 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-2782 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 03 - 1-- 2025 0635 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD N BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MAPLEVALLEYWHY
0 4 29
UNIT 01 VEHICLE
MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 0 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY MOUNTLAKE TERRACE ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 1❑ P1 LICENE 14 CJT3552 sTAT WA u N# 1 GCDM19W3Y6110947
11[—jTRAILER STAE TRAILER STATE
11 3 0 PLATE# PLATE# FR.. ro
TRLR. A'RLR. 1 3 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 2 2000 CHEV ASTRO DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO VICTOR CANADA HERNADEZ 816 DAYTON AVE NE RENTON WA 98056 D:4258910267 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2062450528
16 a
LAST NAME TORELL FIRST NAME JOSHUA MIDDLE IT
INITIAL
17❑ STREET NEW ADDRESS❑' 4801 214TH LN SW#11 CITY MOUNTLAKE TERRACE ST' WA ZIP 98043 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
LICENSE I ❑21❑ PLA E# CNJ7997 TATE WA VIN# 41
SYJYGDEE9MF159133 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE TESL MODEL Y STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO IRENE LEE 4801214TH LN SW#11 MOUNTLAKE TERRACE WA 98043 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EF77882
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2782
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'
wht/1 It outside turned into side of gray/2
Within the city limits of Renton/King/Wa I was dispatched to a phone/hit and run that occurred at the
intersection of Sunset Blvd N and Maple Valley Hwy.
I contacted the victim/unit 2 by phone. He told me he was south on Sunset Blvd N making a left onto
Maple Valley Hwy on the inside left turn lane when unit 1 swerved towards his vehicle while also
turning left. Unit 2 said the van contacted the side of his vehicle causing some scratches. Unit 2 told
me he followed unit 1 and was able to get him to pull over for an info exchange. Unit 1 left shortly
after they stopped without providing his information. Unit 2 just wanted to settle this so he could get
his vehicle damage repaired. Unit 2 said he may be able to ID the driver of unit 1.
Unit 2 described unit 1 as a Latin male with some facial hair. I called Victor several times with no
answer and was unable to locate his vehicle at the listed address.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 3/28/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-28-25 02:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
M.LEVERTON 2517 312812025 3:22:50 PM
BADGE OR ID# 2517 OR]#' > WA0171300 TIME POLICE DISPATCHED; 6:45 AM TIME POLICE ARRIVED]6:49 AM
PART I PAGE IT]OF 3�
REPORT NO. EF77882 CASE# 25-2782 DATE AND TIME 03/28/25 06:35
OF COLLISION
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