HomeMy WebLinkAbout25-2999 25-2299 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971 25-2999 25-2299 2
El
CASE#
INTERSTATE ❑ CITY STREET STATE ROUTE OTHER LOCAL AOENC 4Y00 3
CODING
COUNTY RD PRIVATE WAY
2 2 TRIBAL 02 TOTAL#OF OBJECT 1 1 8 28
UNITS ! ❑
RESERVATION STRUCK
' 2
3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cat�usloN' 03 - 13 - 2025 2139 17 ❑.= E IN e 1070 3
S 8
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 10TH ST BLOCK NO. [: 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ W❑ MONROE AVE NE
OF,1 29
(� � MOTOR ❑ PEDAL- El DAMAGE THRESHOLD MET PHONE
VEHICLE CYCLE. YES NO �/ D:4252602712 0 1 30
LAST NAME RODRIGUEZ RAMIREZ FIRST NAME MA DEL REFUGIO MIDDLE p
5 INITIAL 1 2 31
STREET ❑, 1118 OLYMPIA AVE NE CITY RENTON ST WA 7jp, 98056 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NOZ INTERLOCKYEs NO Z/ YES R No,/
8❑ LRIENSE# STATE WA SEXI F MM D Y' 07 — 04 — 1975 1 1 2 32
9❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES 2❑
❑10 2❑ I P1 ATNFS# BPN0785 sTAr WWAV N# 1 FM5K8AR6EG891185 3
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] 3 34
13 4 2014 FORD EXPLOR 4D DAMAGE YES NO YES[:] No./
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 Y
SHADE IN DAMAGED AREA ❑ 35
❑ LIABILITV INSURANCE❑ INSURANCE CO <1�3 4
14 PROGRESSIVE 910463869LI EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLv YES❑NO CITATION# OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
16� VEHICLE
UNIT 02 CYCLE OWNER YES NO❑✓ ❑ PEDESTRIAN ❑ ❑ �/ D:2064075541
:
LAST NAME MURUKI FIRST NAME RUTH MIDDLE N
INITIAL
17❑ NEW STREETR 2319 S 7 286TH ST CITY FEDERAL WAY ST WA ZIP 98003 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LDIIVEW # STATE WA ]SEX IF M .C... 02 _ 05 _ 1947 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS PAIN GENERAL
❑ 41
21❑ PLA E# BCK1355 TArE WA vIN1i 1G8ZR57537F317994 1
42
22❑ PLATE# STATE PLATE#ILER STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2007 MAKE SATU MODEL A(/RA STYLE $D VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YESfj
NO�/ YES NO�/
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADEd DAtYGE$AREA
LIABILITY INSURANCE I PORGY#ECO MITSUI SUMITOMO INSURANCE TRI1000051-2636-02 1 4� L3� �d5
IN EFFECT Ri
VE—LE ❑ ,J� CITATION# CHARGE GQ
LEGALLY YES N`L J
25 s � a
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EF75840
COLLISION REPORT III III III III III 111
1591972 CASE# 1 25-2999 25-2299
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TAYLOR LARISA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
4252602712 SEXi F MMDDYYYY 07 - 04 - 1975
----------------------------
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 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'
Unit 2 was traveling northbound on Monroe Ave NE approaching a stop sign at NE 10th ST. Unit 2
stops and proceeds through the intersection, while in the middle of the intersection Unit 2 is struck by
Unit 1 whom was traveling eastbound on NE 10th ST. It was reported by witness Larissa Taylor that
Unit 1 failed to fully stop at the stop sign and performed a rolling stop which caused Unit 1 to collide
with Unit 2. Larissa reported that Unit 2 stopped at their stop sign and were in the middle of the
intersection at the time they were struck by Unit 1.
Unit 1 reported that they had fully stopped at the sign and that Unit 2 had run through the stop sign.
Unit 2 had substanstial damage to their entire passenger side, along with full passenger side airbag
deployment. The vehicle was still able to drive under it's own power. Unit 2 was evaluated by the fire
department and reported to have pain all over her body.
Unit 1 had minor non reportable damage to their front bumper. Unit 1 reported no injuries and was
able to leave the scene in their vehicle.
There is no further information.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by J. Turner 12650 on 03/14/2025 at 0315hours.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 03-14-25 03:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 312112025 8:22:02 PM
BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED 9:39 PM TIME POLICE ARRIVED';9:43 PM
PART PAGE IT]OF
REPORT NO. EF75840 CASE# 25-2999 25-2299 DATE AND TIME 03/13/25 21:39
OF COLLISION
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