HomeMy WebLinkAbout26-539 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG70272OLCERA
COLLISION REPORT 1591971
❑ 0✓ RESULTED I
CASE 26-539 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 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
eDL�ISION' 01 - 19 - 2026 1441 17 =.= S 8 W❑ INOF 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 20 00 FEET e✓ S 8✓ E e S 3RD ST
2 0 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4253991567 0 1 30
6 LAST NAME MARRA RODRIGUEZ FIRST NAME ROBERTO MIDDLE t 1 2 31
INITIAL
STREET ❑ 520 S KELSEY ST APT 9 CITY; MONROE ST WA ZIP 98272 2
NEW ADDRESS
7 COE IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ✓NO INTERLOCKYES NO✓ YES F NO;✓
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 09 - 10 - 1999 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2❑
LICENSE, C41870V STATE WA VIN# 54DK6S16XMSG70041 3
10 Fq I PI ATP tt
TRAILER TRAILER
11 2 5❑ STATE STATE PLATE# PLATE# ROM To
TRLR zRLR 1 5 33
12 2 $ VIN#' VIN#
FROM TO
VEH.YEAR 2021 MAKE ISO MODEL FTR STYLE CG VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE 1 $ 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO NORTHWESTBUILD.G SUPPLIES 7303 W BOSTIAN RD#C2 WOODINVILLE WA 98072 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 14 LIABILITY INSURANCE❑ INSURANCE CO CONTINENTAL WESTERN 6038759-23 4
IN EFFECT &POLICY# 9TOP _
YEs
IALLNc ❑NO❑ CITATION# 6A0059423 CHARGE IMPROPER LANE USAGE t s taoorrob z 36
15❑
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2063210485
16�
LAST NAME OGUNLEYE FIRST NAME JUDE MIDDLE A
INITIAL
STREET ❑
17 ❑ 1401 JONES AVE NE CITY RENTON ST, WA ZIP 98056 37
NEW ADORE SS
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
CDL INTERLOCKYEs NO✓ INTERLOCK YES NO
Fc
✓ YES NO✓
19 DRIVER'S STATE WA SEX M D.O.B. 03 23 1963 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[ LICENSE CLE9962 rarE WA VIN# 7SAYGDEE2RF984392 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2Q24 MAKE TESL MODEL MODEL Y STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYER E No✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE 087452526
IN EFFECT &POLICY# I STOP
1—
L YES❑ N.I—I, CITATION# CHARGE to BOTTOM
LE
L,—
25 s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
❑
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG70272
COLLISION REPORT III III III III III 111
1591972 CASE# 26-539
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 INJURY NATURE OF INJURIES
POS. ' USE GLASS 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 CLASS ----�
: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
Unit 2 southbound in curb (#2) lane of Main Ave S. Unit 1 southbound in center (#1) lane Main Ave S.
Driver 1 lbarra Rodriguez told me that he started to change lanes into #2 lane, and did not see unit 2.
Unit 1 was a large box truck; the truck's steel step on the passenger side hit unit 2, as did unit 1's right
front wheel. The lug nuts on the right front wheel damaged unit 2's left rear wheel, wheel well area,
and tire. The impact pushed unit 2 into the curb, damaging the right rear wheel and tire. Driver 1
lbarra Rodriguez was cited via complaint for improper lane usage.
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 01-19-26 03:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 112012026 4:35:33 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:42 PM TIME POLICE ARRIVED i 2:47 PM
D'ART B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG70272 CASE# 26-539 DATE AND TIME 01/19/2614:41
OF COLLISION
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