HomeMy WebLinkAbout26-4572 TFFiNouCERA II I III 1 III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-4572 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION' 06 - 1-- 2026 1249 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e DAMS AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:3606435553 0 81
30
6� LAST NAME GAMEZCALIX FIRSTNAME JAFETH MIDDLE E 1 1 2 31
INITIAL
STREET ❑, 16572 167TH ST SE CITY MONROE ST WA ZIP 98272 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO,/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 10 - 12 - 2007 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CUY4103 sTATI WAurN# 3VWFP7AT7DM644263
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2013 VOLK BEETLE HB DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ERLIN MEJ/ALOPEZ 18727 BLUEBERRY LN APT E102 MONROE WA 98272 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 10BOTTOM 5 36
EGHALLY YES❑NO CITATION# 6A0325699,6A0325699, FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 8 6
MOTOR PEDAL- 'pEpESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063001282
16 a
LAST NAME ZHU FIRST NAME XIAO MIDDLE
INITIAL
17❑ STREET ❑', 12504 SE 53RD ST CITY' BELLEVUE ST' WA ZIP 98006 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YES❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE CLASS NECK FEELS STRANGE
21❑ LICENSE I CTY0105 TATe WA vIN# 5TDEBRCH1SS685244
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2025 MAKE 7'Dy7' MODEL yIGHLAN STYLE UT DAMAGE TO WED NOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU POLICY#E CO SAFECO H1887550 1 9TOP
vewGLELEGALLY YES N CITATION# CHARGEIN i o BOTTOM
�
25❑ JAGENCY
s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
R.ONISHI 5738 WA0171300
1
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EH14613
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4572
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) ZHANG SHI
ADDRESS&PHONE# D O.B. '
12504 SE 53RD ST BELLEVUE WA 98006 SEXi F MMDDYyry 07 - 21 - 1958
PASSENGER WITNESS UNIT# 2 PQS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE CLASS
1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 2 stopped at red left turn signal from eastbound S 43rd St to northbound 1-405. Unit 1 eastbound
directly behind unit 2, and ran into rear of unit 2. Minor visible damage to trailer hitch and rear bumper
of unit 2, damage to front bumper and bumper skin of unit 1. Driver 1 Gamez Calix spoke with me
through my Axon translation faculty, Spanish to English. Gamez Calix admitted to having run into the
back of unit 2, and told me that he did not have a driver's license or any kind of official identification.
Gamez Calix said that unit 1 belonged to an acquaintance, and that he had no insurance. Gamez
Calix did show both an SID and an FBI number; his brother Edgar Gamez came to the scene with
another licensed driver, and I released the car to them. I cited Gamez Calix for NVOL, and issued him
a notice of infraction for Following Too Closely and no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-12-26 03:58 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 6/23/2026 3:43:16 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED 12:58 PM TIME POLICE ARRIVED 4:09 Pry]
PART I PAGE IT]OF 3�
REPORTNO.! EH14613 CASE# 26-4572 DATE AND TIME 06/12/2612:49
OF COLLISION
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