HomeMy WebLinkAbout25-5726 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-5726 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 7 2$
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 07 - 01 - 2025 2036 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HARDIE AVE SW
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW V/CTOR/A ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2066651753 0 11
30
6� LAST NAME RAMIREZ FIRSTNAME DANIELA MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 556 STEVENS AVE NW CITY RENTON ST WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑
USE CLASS j I KNEE PAIN AND SWELLING IN BOTH KNEES
3
LICENSE CSJO116 STATE WA VINIf 3C4NJDAB1JT261863
10[2 1 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 A 2018 JEEP COMPA SD DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO DANIELA RAMIREZ 556 STEVENS AVE NW RENTON WA 98057 D:2066651753 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
A INSURANCE CO 2 3 4
14 LIABILITY INSURANCE STATE FARM 449-6402-D1247
IN EFFECT &POLICY# � 9TOP
VE—LE CHARGE 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 8
UNIT 02 VEHICMOTOLE CYCLE ❑ PEDESTRIAN ❑ OWNER
❑ DYES NO OLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP 4
17❑ NEW ADDRESS ❑ 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 LLIICENS # STATE SEX U MMDDYY -❑_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑21❑ TATE LICENSE vIN1 41
1
PLATE#
42
22❑ PIR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED By Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO (NEWJ RENTON VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEVIN PETERSON 12808 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG05888
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5726
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RAMIREZ DIANA E
(IAST FIRST,
ADDRESS&PHONE# D.0
.B.
556 STEVENS AVE NW RENTON WA 98057 SEXi F MMDDYyry 11 - 18 - 2006
--------------------------
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS E UNIT# 1 POS 3 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS '6 NATURE F INJURI E M PAIN UPPER
NAME
(LAST,FIRST,MIDDLE INITIAL) RAMIREZ MIA C
ADDRESS&PHONE# DOB
556 STEVENS AVE NW RENTON WA 98057 SEX' F MMDOYY,Y 11 _ 08 _ 2022
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS $ AIRBAG 6 RESTR. 10 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) CHEN JEFFERY C
ADDRESS&PHONE# 210 NW 5TH ST RENTON WA 98057 9096540716 SEX MI. 11 _ 1994
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
I was dispatched to a collision on 07/01/25 at 2037 hours I was dispatched to a hit and run with
injuries at Hardie Ave SW and SW Victoria St, in city Renton, King County WA.
Unit 1 Unknown Driver: Unknown
Unit 2 CSJ0116 Driver: Daniela A. Ramirez (DOB 01/14/2002)
Upon arriving I could see Unit 2 was up on the curb of the intersection both passengers where out of
the car and the driver was still in driver seat. Fire was on scene and evaluating all personal. I spoke
to the driver of Unit 2 who told me that she was traveling South on Hardie Ave SW after stopping at
the stop sign. As she almost cleared the intersection Unit 1 who was traveling West on SW Victoria St
when he blew though the stop sign hitting Unit 2 on the rear driver side of the vehicle spinning the
vehicle around. Unit 1 then sped off West on SW Victoria St.
Unit 2's driver had swelling in her right knee and left with pain in her arm as well as tingling in her
feet. The front passenger had pain in her knees left arm and upper lip. The baby in the rear of the
vehicle unknow if any injuries. The driver of Unit 2 was transported to Valley Medical Center via
TriMed and the passenger and baby were driven to Valley Medical Center via the parents of Unit 2.
Photos were taken on scene and uploaded to evidence.
The witness submitted a video of the suspect vehicle which was a black SUV heavy front-end
damage. Area checked for the suspect vehicle and notified county.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 07/02/2025, 0007 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 07-02-25 12:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 1 71212025 8:24:13 AM
BADGE OR ID# 1Y808 OR]# WA0171300 TIME POLICE DISPATCHED 8:37 PM TIME POLICE ARRIVED 8:40 PM
PART I PAGE IT]OF 3�
REPORT NO. EG05888 CASE# 25-5726 DATE AND TIME 07/01/25 20:36
OF COLLISION
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