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HomeMy WebLinkAbout26-2856 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG93870OLCERA COLLISION REPORT 1591971 CASE# 26-2856 2 INTERSTATE CITY STREET El 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# eaCL s o v' 04 - 12 - 2026 0450 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION �✓ SE 160TH ST BLOCK NO. e 12100 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 3001.1 00 FEET e✓ S 8 W e ?21ST AVE SE 0 1 29 MOTOR ✓ PEDAL- F DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES ✓NO 1 4 30 5 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET F� CITY', ST ZIP 2 NEW ADDRESS 7� +COL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCKVEs NO YES NO 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' -�- 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, 3 10 F1 PI ATF# STATE V(N TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# ROM To TRLR TRLR 3 7 33 12 0 Q VIN#'. VIN#: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BUN TOWEBBv GOVT VEHICLE 34 13� DAMAGE YES�NO� YES NO REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE ElNSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP vEnic�E 5 STM Lemur Yes❑NO❑ CITATION# CHARGE 36 t a 80TTOM 15❑ IALLYc s 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES�/ NO D:4256812164 16❑ LAST NAME ALVAREZ FIRST NAME BRENDA MIDDLE' / INITIAL 17 F1 STREET ❑ SS 12130 SE 160TH ST CITY' RENTON ST, WA ZIP 98058 g 37 NEW ADDRESS 18� IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 CDL INTERLOCKYES No INTERLOCK YES NO YES NO 19[ LICENS # SrATE SEX U MMD YY ?2 15 ?975 39 HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 9 USE 9 CLASS 0 ❑ LICENSE 318XOP TATE I WA VIN# 5FNYF18688BO32742 21 PLATE# 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE E 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR ZQQ$ MAKE HOND MODEL PILOT STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO BRENDA ALVAREZ 12130 SE 160TH ST RENTON WA 98058 D:4256812164 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO USAA 014572283 7104 IN EFFECT &POLICY# t vemae LEGALLY YES❑ N.I—I, CITATION11 CHARGE U�o 25 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. EG93870 COLLISION REPORT III III III III III 111 1591972 CASE# 26-2856 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 legally parked on north shoulder of SE 160th St, facing west. Unit 2 was parked in front of owner Brenda Alvarez' home. Alvarez heard sound of collision; by the time that she got outside, causing vehicle was gone. Unit 2 suffered scrape damage on left side from rear of car to front wheel. Parts of Unit 1 remained in the street; front bumper liner, exterior rearview mirror parts, front light cover fragments. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 04-12-26 06:05 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE JESSE VANDERHOEK 11631 411212026 3:58:37 PM BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 5:02 AM TIME POLICE ARRIVED i 5:13 AM (PART B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EG93870 CASE# 26-2856 DATE AND TIME 04/12/2604:50 OF COLLISION Z qqq f4 j S 1. O E rc t� t Y } £ t �t � i a�' l 5S i PAGE 3 OF 3