HomeMy WebLinkAbout25-2804 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF81805oc� RA
COLLISION REPORT 1591971
CASE# 25-2804 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 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#
DATE OF N E
cDLLISION' 03 - 28 - 2025 1828 17 =.= S 8 W e INOF 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e 3200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 150 00 FEET e✓ S 8 E e MONROE AVE NE
OF 4 29
MOTOR PEDAL- DAMAG THRESHOLD MET E
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO ✓ PHON 0 1 30
LAST NAME HERNANDEZ FERNANDEZ FIRST NAME FERNANDO MIDDLE
6 INITIAL 1 2 31
STREET ❑ 12244 SW 304TH ST CITY; FEDERAL WAY ST WA ZIP 98023 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
IN7ERLOCKYES NO✓ INTERLOCKYEs NO✓ YES F NO
8 DRIVERI # STATE WA SEX I M MMD4YY' 03 — 16 — 1997 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET 2 CLASSY 1 NATURE of INJURIES 2
10 at ENSttEI D69187B STATE WA VIN# 54DC4W1D1PS203575 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR TRLR 5 1 7 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2023 MAKE ISU MODEL NPR STYLE TR VEHICLE TOWED TO ZBLIN TOWED BY GOVT VEHICLE
13 D 7 $ 34
DAMAGE YES I_II NO YESII_I) NO✓
REGISTERED OWNER INFO ,DIRECT BUYING SERVICE 1NC 17491STAVE S SEATTLE WA 98134 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 NSURANCE CO 3 4
14 ABILITY INSURANCE FIREMEN'S INSURANCE CO.CPA606003720
IN EFFECT &POLICY# 4TOP
V""' CHARGE 7 0 80TTOM 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 7 e
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 VEHICLE CYCLE nWNFR
16�
LAST NAME RODRIGUEZ RODRIGUEZ FIRST NAME REY MIDDLE C
INITIAL
STREET ❑
17 ❑ 1222 SUMMIT AVE APT 209 CITY FEDERAL WAY ST, WA ZIP 98101 q 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKvEs ND✓ INTERLOCK YES No✓ YEs NO✓
19 DRIVER'S STATE WA SEX M D.O.s. 01 06 1992 39
LICENSE# MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICEN E BVU3057 rArE WA vIN# KL4CJESB4LB061554 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE BUI(, MODEL ENCORE STYLE p4 VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ NO✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
NQ.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 952512242
IN EFFECT &POLICY# 9TOP
VEHICLE LEGALLY YES❑ N,J—J I CITATION# CHARGE t080TTOM
`.L
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MARIA FERNANDES 12848 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF81805
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2804
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 NJURY NATURE OF INJURIES
POS. ' USE CLASS 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
Vehicle 1 was in the parking lot of Chevron (3209 NE 4TH ST Renton, WA). Vehicle 1 attempted to
pull out of the north driveway and take a left (westbound) onto NE 4TH ST. Vehicles driving in two of
the eastbound lanes of NE 4TH ST stopped for Vehicle 1 so he could make the left turn.
Vehicle 2 was driving eastbound in the 3200 block of NE 4TH ST in the left hand turn lane, to turn
north onto Monroe AVE NE. Vehicle 1 bypassed the vehicles that had stopped for him, but struck
vehicle 2 before he could turn left onto NE 4TH ST. Vehicle 1 did not grant right of way to Vehicle 2.
The front left bumper of vehicle 1 struck the front right bumper of vehicle 2. There was minor damage
and both vehicles were driveable. There were no reported injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MARIA FERNANDES O4-11-25 09:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 4/11/2025 10:51:31 PM
BADGE OR ID# 12848 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:28 PM TIME POLICE ARRIVED i 6:28 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. E F81805 CASE# 25-2804 DATE AND TIME 03/28/25 18:28
OF COLLISION
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