HomeMy WebLinkAbout26-592 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG70913OLCERA
COLLISION REPORT 1591971
❑ 0 RESULTED I
$ 26-592 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4100 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 IN eDLLISION' 01 - 21 - 2026 1757 17 =.= S 8 W❑ OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK ST e
4a MILE POST 4600 .�
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e DUVALL AV NE
0 3 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE
❑ CYCLE ❑ YES No �/ D:2063512056 30
6 LAST NAME PEREZ VILLA TORO FIRST NAME CARLOS MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 5615 NE 2ND ST CITY; RENTON I ST WA I ZIP; 980594870 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION ENT MEDICAL TRANSPORTED' 3
INTERLOCKYES NO✓ INTERLOCK Yet
Na✓ YES F NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 05 - 14 - 1978 ❑32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2❑
10 1� aiCENSE BWP8971 STATE WA VIN# 1N4AL2AP1CC210361 3�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM 7
T.
TRLR rRLR 1 7 33
12 jj
VIN#' IN
#
: FROM TO
VEH.YEAR ZOI2 MAKE NISS MODEL qL�-IMq STYLE SD VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 $ 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO CARLOS PEREZ VILLA TOR.5615 NE 21VD ST RENTON INA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 14 LIABILITY INSURANCE❑ INSURANCE CO PATRIOT GENERAL INS 114084890 4
IN EFFECT &POLICY# 9TOP _
srn Nowc Yes❑NO❑ CITATION# 6AO073359 CHARGE FAIL YIELD TO PEDESTRIAN s taoorrob z 36
15❑
❑ EDAL-:. ❑ PEDESTRIAN QPROPERTY PHONE
UNIT 02 VMEOHTIOCRLE CPYCLE OWNER D:80 42466459
YES✓ NO
16�
LAST NAME PALOR FIRST NAME JONALIZA MIDDLE R
INITIAL
17 STREET ❑ 258 SHADOW PL SE CITY RENTON ST, WA ZIP 37
980597058
NEW ADDRESS I I I I I 1
❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED: 38
INTERLOCKYEs NO INTERLOC(£YES xz YES NO
19❑ DRIVER'S STATE WA SEXI F I DXI'B Til 19 1975 39
LICENSE# MMDDYY
20 ON DUTY❑ STATUS 3 AIRBAG RESTR EJECT HELMET INJURY 6 NATURE OF INJURIES ❑ 40
USE CLASS RIGHT ARM,HIPS,LEGS
21❑ I LICENSE
PLATE# T-1- VIN# 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 0 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
1-1— ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NC
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
HANSEN HSU 12651 WA0171300
26❑
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG70913
COLLISION REPORT III III III III III 111
1591972 CASE# 26-592
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) BAUTISTA LARA
ADDRESS&PHONE# D�
5615 NE 2ND ST RENTON WA 980594870 2063512056 SEXi F M D.O B.Y 08 — 13 — 1978
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 3 2 4 1 USE CLASS i 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) PEREZ BAUTISTA AMERICA
ADDRESS R PHONE# D O B
5615 NE 2ND ST RENTON WA 980594870 2063512056 SEX F MMQavvvr 11 _ 09 _ 2009
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# 1 SOS. ' 9 AIRBAG 1 RESTR. 4 EJECT 1 USE CLASS 1 ----�
NAME MIDDLE INITIAL) THOMPSON GUY
(LAST,FIRST,
ADDRESS&PHONE# 2069209987 SEX M _
D.O.B.
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY; NATUREOFINJURIES
Z' POS. USE CLASS
NARRATIVE
Unit 1 traveling south along Duvall Av NE at intersection of NE Sunset Blvd. Unit 1 making right turn
at intersection onto westbound NE Sunset Blvd. Unit 2 pedestrian walking south on sidewalk of
Duvall Av NE at intersection of NE Sunset Blvd, NW corner of intersection. Unit 2 enters marked
cross walk southbound. Unit 1 driver does not see Unit 2 and strikes Unit 2 causing non reportable
non disabling front end damage to Unit 1 and reportable disabling damage to Unit 2, right arm, hips,
and legs. Non critical injuries. Unit 2 was treated on scene by Renton Fire and transported to hospital.
Unit 1 driver was proximate cause of collision as he failed to yield right of way to pedestrian crossing
marked cross walk.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 01-21-26 07:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1/21/2026 8:57:07 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 5:58 PM TIME POLICE ARRIVED i 6:00 PM
(PART B 3 Da-3mx-attar gt 1Mffp PAGE 2�OF 4
REPORT NO. EG70913 CASE# 26-592 DATE AND TIME 01/21/26 17:57
OF COLLISION
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REPORT NO. EG70913 CASE# 26-592 DATE AND TIME 01/21/26 17:57
OF COLLISION
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