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HomeMy WebLinkAbout25-80916 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG62816OLCERA COLLISION REPORT 1591971 INTERSTATE CITY STREET El CASE# 25-80916 2 STATE ROUTE OTHER LOCAI-A`NG 4250 3 C©DINGCOUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s o v' 12 - 21 - 2025 1553 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S 4TH ST BLOCK NO. e 1000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET a S 8 W e MAIN AV S 0 1 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO ✓ 0 8 30 5 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET F� NEW ADDRESS CITY', RENTON ST: ZIP: 2 7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCK YES NO✓ INTERLOCKYES NO✓ YES NOW 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' -=- 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 9 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, UNKNOWN 3 10� PI ATP# STATE V(N TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# 11ROM To TRLR TRLR 33 12 0 0 VIN#' vIN# FROM TO VEH.YEAR MAKE UNKN MODEL UNKNO STYLE SV VEHICLE TOWED fn TO BUN TOWED By GOVT VEHICLE 9 9 34 13 DAMAGE YES NO ✓ YE S❑ NO✓ REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 4TOP VEnicLE CHARGE t 5 36 LEc Lv YES❑NO❑ CITATION# 70 80TTOM 15❑ sTnNowc 7 e MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE PROPSnWNr YES�/ NO D:2068830659 16� LAST NAME MARTINEZ GONZALEZ FIRST NAME NANCY MIDDLE M INITIAL 17 F1 STREET ❑ ❑ 16320 120TH A V SE CITY RENTON ST, Wq ZIP 98058 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED'1 ❑ 38 INTERLOCKYEs No✓ INTERLOCI£YEB NO Fv YEs NO'✓ 19 DRIVE # INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSLATE E BHA1076 rare WA vIN# 4T1BE32K44U884741 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2004 MAKE TOYT MODEL CgMRy STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO NANCY MARTINEZ GONZALEZ 16320120TH AVSE RENTONWA98058 D:2068830659 VEHICLE NO.2 SHADE IN DAGED AREA 2 4 LIABILITY INSURANCE[Z INSURANCE CO ALL STATE 920448634 IN EFFECT &POLICY# 9TOP ve w1— ,.I—] CITATION11 CHARGE to BOTTOM L','—LY YESZ N 25 a e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG62816 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80916 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CIASS ----� :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 Scene not observed. Hit and run. No injuries. Unit 1 strikes Unit 2 at intersection of S 4th St and Main Av S. Unit 1 described as black SUV, no make, model, or license plate. No description of Unit 1 driver. No actionable leads. Unit 2 driver reports Unit 2 sustained reportable non disabling passenger side damage. No injuries. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 12-21-25 06:59 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 1 12/26/2025 12:18:04 AM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:21 Pry] TIME POLICE ARRIVED i 4:25 PM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. EG62816 CASE# 25-80916 DATE AND TIME 12/21/25 15:53 OF COLLISION { x, We' �` s q 2:13 1 4 v PAGE 3 OF 3