HomeMy WebLinkAbout25-2694 OLICETRAFFIC II I III I III I I III I I IIII III III REPORT NO. EF79343 0 5 27
j COLLISION REPORT 1591971
CASE# 25-2694 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4100 3[--�
COUNTY RD ❑ NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
cDUISION' 03 - 25 - 2025 1708 17 =.�� S WE IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE SUNSET BLVD BLOCK ST e
4a MILE POST 2700 .�
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 00 FEET e✓ S 8✓ W e NE 10TH ST
IF 2 29
MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533358147 0 1 30
5 LAST NAME LEE FIRST NAME CHRISTOPHER MIDDLE P 1 1 2 31
INITIAL
STREET ❑ 1204 N 10TH PL APT 2444 CITY RENTON ST WA ZIP 980575668 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYEs Na✓ YES D NO F✓
8 �CIENS # STATE WA SEX MMOCSYY' 02 — 12 — 2000 1 2 32
9 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT, 1 HELMET INJURY 6 NATURE of INJURIES 2
USE ;CLASS ABRASION RIGHT FOREARM
LICENSE CBF4701 STATE WA VN# 1G4GC5G34FF222853 3
10[9� PI ATF#'
11[—j— TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
rRLR rRLR 7 5 33
12 3 5 VIN# vI.
( FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2015 BUIC LACRO SD DAMAGE YES NO ✓ YEs No✓ 5 1 34
REGISTERED OWNER INFO RICHARD LEE 2218159TH STREET CTE TACOMA WA 98445 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 2 3 4
LIABILITY INSURANCE INSURANCE CO
14 Z ALLSTATE 007643643
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ sTnNowc 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT OZ VEHICLE ❑ cYDLE' ❑ ❑ PROPnWNFR YEs / No D:4254964335
16�
LAST NAME GONZALEZ GUTIERREZ FIRST NAME SAUL MIDDLE I N
INITIAL
STREET ❑ 37
17 '❑ 2609 NE 9TH ST CITY RENTON ST, WA ZIP 980563038
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38
INTERLOCKYEs NO✓ fNTERLOCKYEs NO✓ YES No;✓
19 DRIVER'S STATE WA SEX M D.O.E. 07 27 1984 ❑ 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENS D98770F rarE W/a vIN# 1FTFW1EV6AFB26283 41
22❑ PLATE# STATE PAAILER
TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2010 MAKE FORD MODEL F150 STYLE TR VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO AXCEL RODRIGUEZ-GONZALEZ 2609 NE 9TH ST RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO PATRIOT GEN 11409763059
IN EFFECT &POLICY# 9TOP
vewaE ❑ ,.I—I CITATION11 CHARGE t080TTOM
LEGnLLv YES N J
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF79343
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2694
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} GONZALEZPEDROZA JAYDEN
(LAST,FIRST
ADDRESS&PHONE# DOB
2609 NE 9TH ST RENTON WA 980563036 4254964335 SEX' M MMDDYYYv 03 - 08 - 2015
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z Q 2 POS. 9 2 4 1 USE CLASS ;1 ---�
'NAME
LAsr F RST,MIDDLE INITIAL) GONZALEZ PEDROZA JEDRIC S
ADDRESS&PHONE# D C,B
2609 NE 9TH ST RENTON WA 980563036 4254964335 SEX' M MMDDYYYY 02 _ 26 _ 2013
NATURE OF INJURIE
SEAT HELMET INJURY
S
PASSENGER WITNESS UNIT# : 2 SEAPOS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M —T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----j
NARRATIVE
Unit 1 entering/merging into traffic along the 2700 block of NE Sunset Blvd onto NE Sunset Blvd. Unit
2 traveling northbound along the 2700 block of NE Sunset Blvd, in the left lane of travel. Unit 1 failed
to yield right of way when entering/merging into traffic, making a left turn, causing major reportable
disabling front end damage to Unit 1 and minor reportable non disabling damage to the front of Unit 2.
Unit 1 driver sustained a bleeding abrasion to his right forearm from the apparent impact of the
deployment of driver side airbag. Unit 1 driver treated on scene by Renton Fire. No other injuries
reported. Proximate cause of collision was Unit 1 driver for failing to yield ROW.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 03-25-25 07:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
BRYAN GROZAV 12489 41212025 9:11:20 PM
BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:11 PM TIME POLICE ARRIVED 5:15 PM
PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EF79343 CASE# 25-2694 DATE AND TIME 03/25/25 17:08
OF COLLISION
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