HomeMy WebLinkAbout25-8952 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG50775OLCERA
COLLISION REPORT 1591971
CASE# 25-8952 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LQCAI-AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 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 IN eDLLIs[oN' 10 - 16 - 2025 0719 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAIN AVE S BLOCK NO. e 300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e S 3RD ST
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2063870799 0 3 30
LAST NAME GUTIERREZ CABALLERO FIRST NAME IVAN MIDDLE p
6 INITIAL 1 2 31
STREET ] 14429 8TH AVE SW APT 8 CITY; BURIEN ST WA ZIP; 981661577 2
NEW ADDRESS
7 CDL IGN RES
�/
IGNITION REQUIRED IGNITION PENT MEDICAL TRANSPORTED' 3
INTERLOCKYEs No INTERLOCKYEs N YES NO
8 DCIENSE# STATE WA SEXI M MMDDYY' 07 — 18 — 1995 1 2 32
9� ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, C68781K STATE WA VIN#; 54DC4W1B9KS800917 3
10 Fl I PI ATF rt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR zRLR 5 3 33
12 2 5 TRLR vIN#
FROM TO
VERYEAR 2019 MAKE ISU MODEL NPR HD STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE g 3 34
13 DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO ROBERTO CRUZ 2430335TH AVE S KENT WA 98032 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 STATE FARM 443-7797-E29-47
IN EFFECT &POLICY# 4TOP
V""' CHARGE t S 36
LEGALLY YES❑NO❑ CITATION# 7 0 BOTTOM
15❑ STANDING 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ THR NO D:2535088667
16�
LAST NAME DELGADO GOMEZ FIRST NAME CARMINA MIDDLE N
INITIAL
❑
17 STREET ❑ 977 26TH PL NE CITY AUBURN ST, WA ZIP 98002 37
2457 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYES Nb� INTERLOCK YES NOF YES NO
19 DRIVER'S STATE WA SEX F D.Q.B. 04 22 1972 39
LICENSE# MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS ' LOWER BACK PAIN
21 LICEN E LATEICAZ7649 rare WA vIN# 3CZRU6H54KM720734 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2019 MAKE HOND MODEL HR-V STYLE 5D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24= DAMAGE YES NO� VES NO
REGISTERED OWNER INFO CARMINA DELGADO GOMEZ 97726TH PL NE AUBURN WA 98002 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 997586001
IN EFFECT &POLICY# 9TOP
LVEHICLE
'—LY YES❑ N.I,—I CITATION11 CHARGE to BOTTOM
LEGALL
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG50775
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8952
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) MERINO MARTINEZ BENANCIO N
ADDRESS&PHONE# D�
3900 VETERANS DR APT J310 KENT WA 980323948 SEXi M MMDDYYYY 08 - 12 - 1973
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�, 1 POS. 8 '2 4 1 USE ':CLASS
:NAME
Lnsr EIRST,MIDDLE INITIAL) MONZONCORADO OLIVER R
ADDRESS R PHONE#
10029 25TH AVE SW SEATTLE WA 98146 SEX' M D O'e• _ 22 _ 2005
MMDDYYYY 01
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# 1 SOS. ' 8 AIRBAG 1 RESTR. 4 EJECT 1 USE CLASS 1 �----�
: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
On 10-16-25 at about 0722, 1 arrived at the intersection of Mill and Houser for a 2 vehicle collision. I
contacted both vehicles in the roadway. Both drivers identified themselves via WADL. Driver 1 told
me; He drove straight on Main Ave S from lane 1 from the intersection with S 3rd St. Lane 1 is a right
turn only lane. Driver 2 told me she was turning right from lane 2 from the same intersection. Lane 2
is a 2 way go lane. Unit 1 then drove into the passengers side of unit 2. Driver 2 complained of lower
bavck pain, but refused medical attention. Unit 2 had to be towed from the scene. I cited driver 1,
Gutierrez-Caballero via complaint for inattentive driving.
This collision occurred in the city of Renton, County of King.
I declare under penalty of perjury, under the laws of Washington state that the foregoing is true and
correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 11-18-25 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1112012025 3:05:59 PM
BADGE OR ID# j 1953 ORI# WA0171300 TIME POLICE DISPATCHED; 7:20 AM TIME POLICE ARRIVED i 7:22 AM
PAST B 3 Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG50775 CASE# 25-8952 DATE AND TIME 10/16/2507:19
OF COLLISION
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