HomeMy WebLinkAbout25-8847 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EG43316 170
27
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 2$-8847 2 0 5
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3❑
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 10 - 1-- 2025 0455 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a LIND AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532943618 0 11
30
LAST NAME MONTEVERDE ROMERO FIRST NAME ADRIAN MIDDLE A
6 INITIAL 1 2 31
STREET ❑1 25436 109TH CT SE APT K104 CITY KENT ST I WA 7jp, 98030 2
NEW ADDRESS
7❑ CDL I 1/ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO NTERLOCKYEs NO Z/ _YES R NoF,/
LRIIVER #
6 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� A8776129 sTArr WAurN# 2T18URHE1EC150035
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 3 7 34
13 8 2014 TOYT COROL SD DAMAGE YES NOBS YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE PROGRESSIVE 863940651
IN EFFECT &POLICY# 9TOP
vEH .e la CHARGE 10BOTTOM 5 36
YES No CITATION# 5A0730328,5A0730329 NO VALID OPER LICENSE W/OUT
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UN�T p,� ❑✓ ❑ PEDESTRIAN ❑ ❑ YES 1/ NO D:4255030316
VEHICLE CYCLE OWNER 16 a
LAST NAME TRAN FIRST NAME TAN MIDDLE V
INITIAL
17❑ STREET ❑', 11209 S 225TH ST CITY' KENT ST WA ZIP 98031 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑NO� INTERLOCK YEs I I NOF YES
F% No❑
19 DRIVER # STATE WA SEX M M D.C.B. 11 22 _ 1970 39
WELMET INJURY 5 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 USE CLASS CHEST PAIN
21❑ LICENSE ALC8515 TAre WA vIN# 2T3DK4DVOCW089934
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH YEAR 2012 MAKE 7'Dy7' MODEL RAV4 STYLE UT DAMAGE TO ✓WED NOO BLIN TOWED BY OV 44
Yr
H BANKERS YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU POLICY#E CO SAFECO H2582414IN CQl
vE""LE ❑ ,J� CITATION# CHARGE i o
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ONISHI 1
5738 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EG43316
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8847
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ORTIZ ALLISON J
(LAST FIRST,
ADDRESS&PHONE#
3223 S 135TH ST TUKWILA WA 98188 2533913152 SEXi F MMDDYyry 03 - OS - 2003
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. : 3 6 4 1 USE CLASS 1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# Ly O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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 westbound on SW Grady Way at Lind Ave SW, entering intersection on green signal. Unit 1
turning left from eastbound SW Grady Way to northbound Lind Ave SW, on flashing yellow arrow.
Driver 1 Monteverde Romero failed to yield right of way to unit 2; through interpreter (passenger 2
Ortiz), Monteverde Romero was confused by the yellow flashing arrow. Driver 2 Tran examined by
Fire, then transported due to complaint of chest pain. Monteverde Romero cited via complaint for
NVOL and Improper Left Turn.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 10-13-25 06:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 1013112025 3:55:20 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 4:88 AM TIME POLICE ARRIVED{5:03 AM
PART I PAGE IT]OF 3�
REPORT NO. EG43316 CASE# 25-8847 DATE AND TIME 10/13/25 04:55
OF COLLISION
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