HomeMy WebLinkAbout25-6850 ("7—
STATE.w,-" .:.. TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 1 27c .
,one COLLISION REP F 1591971
CASE# 25-6850 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F ❑ LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL LIN 75 TOTAL#OF STRUCK OBJECT 1 U 7 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coATL s ory 08 — O6 — 2025 2110 17 a. S e W❑ OF 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK ST 8
4a MILEPOST 4700
❑ .�
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,� FEET ❑ g ❑ W❑ DUVALL AV NE
OF 8 29
♦� MOTOR PEDAL- DAM E THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO D:2096061771 0 1 30
6 LAST NAME PALERMO FIRST NAME STEVEN MIDDLE A 1 2 31
INITIAL
STREET E:1' 1533 ILWACO AVE NE CITY RENTON WA
NEW ADDRESS S7 ZIP 980594234 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES LINOZ I INTERLOCK YES No W YEs NOW
$❑ LDICENS STATE WA SEX'M MM flYY 12 — 03 — 1955 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H5 E7SR 1 NATURE OF INJURIES 2=
LICn NSE CJT3204 STATE WA WIN# 2T2BCMEA4PC007053 3
10 1❑
11 4 0 PLATE# STATE PLATE#TRAILER STATE FROM To
TRAILER
TRLR TRLR. 9 9 33
12 4 0 VIN#' VIN#
FROM TO
13 4 VEH.YEAR2023 MAKE LEX$ MODEL RX STYLE VEHICLE TOWED FtjT02fBLIN TOWED BY GOVT.VEHIICLNO✓ 7 3 34
DAMAG❑ REGISTERED OWNER INFO LEXUS OF TACOMA AT FIFE 170840THAVENUE CT E FIFE WA 98424 II—ll VEHICLE cNIIDAR
SHADE 1N DAMAGED AREA ❑ 35
4 LIABILITY INSURANCE INSURANCE CO Z ft
14 USAA 005739990C
IN EFFECT &POLICY# i 4TOP
VEHICLE CHARGE ❑ 36
EGA-,v YES NO❑ CITATION# 10 ftOTTOM
15❑ srAnomc a i
MOTOR � PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT ICJ ❑ PEDESTRIAN ❑ ❑ HO 2064653664
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME CRUZ VIELMAN FIRST NAME CARLIDS MIDDLE D
INITIAL.
17❑ STREET El 1604 SW HENDERSON ST CITY SEATTLE I ST, WA ZIP 981062336 37
NEW ADDRESS I I I ❑
1$❑ CDL IGNITION RE®UIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 3$
W7ERLOCKYEs No INTERLOCkCvEs no ves No,�
19❑ DRIVER'#
ON DUTY STATUS AIRBAG'2 RESTR 4 EJECT 1 HELM ET INJURY 1 NATURE of INJURIES 40
CLASS
21❑ LICENSE,CPW0138 TATf'WA vIN# KNDJH741X95018188
❑ 41
PLATE#
TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2009 MAKE K/A MODEL BORREG STYLE $V DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
O
24 YES
REGISTERED OWNER INFO CARLOS CRUZ VIELMAN PO BOX 66223 BURtEN WA 98166 VEHICLE NO.2
SHAD DAMAGED AREA
LIABILITY INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY# 4TOP _ 5
VEHICLE YES NC[:] CITATION# 5A 0663860 CHARGE OP MOT VEH W/OUT INSURANCE,NO Io aonoM
LEGALLY
25 e
OFFICER'S NAME(PRINT)
26 OFFICER PHONE BADGE OR ID# AGENCY
HANSEN HSU 12651 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG16957
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6850
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) PALERMO SAM
ADDRESS&PHONE# D�
1533 ILWACO AVE NE RENTON WA 980594234 2096061771 SEX' MMDDvvYv 01 - 22 - 2010
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ 1 POS. 3 2 4 1 USE CLASS 1 ----�
:NAME
(LAST FIFS7 MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NA7UREOFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
Unit 1 traveling eastbound waiting at the light at the intersection of Duvall Av NE on NE Sunset Blvd.
Unit 2 traveling eastbound behind Unit 1 approaching said intersection on NE Sunset Blvd. Unit 2
rear ends Unit 1, causing reportable non disabling rear damage to Unit 1 and reportable non disabling
front damage to Unit 2. Unit 2 driver was the proximate cause of the collision as he followed too
closely. Unit 2 driver also NVOL with valid ID and had no insurance. Unit 2 driver cited accordingly.
No injuries reported. Unit 2 driver no evidence of impairment.
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 08-06-25 10:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 8/7/2025 5:29:25 PM
BADGE OR ID# 12651 ORI#' i WA0171300 TIME POLICE DISPATCHED; 9:13 PM TIME POLICE ARRIVED i 9:19 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EG 16957 CASE# 25-6850 DATE AND TIME 08/06/25 21:10
OF COLLISION
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