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Home My WebLink About22-13596 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 22-13596 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ H F ❑ LOCAL AOENC 3 HIT IT&RUN CODING COUNTY RD � PRIVATE WAY � INVOLVED 2� TOTAL#OF OBJECT 1 1 8 2$ TRIBAL UNITS 04 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN ✓ CITY# ❑ C{YLLISION 12 - 23 - 2022 0823 17 ❑.= S 8 W IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 27TH PL BLOCK NO. e✓ 500 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 150 00 FEET e S ❑ W e TALBOT RD S 0 1 29 UNIT MOTOR Z PEDAL- CYCLE ElD MYESA,GEE NHORESHOLD MET PHONE 01 1 4 30 6� LAST NAME ORTIZALPISTA FIRSTNAME EMIGDIO MIDDLE 1 1 2 31 INITIAL STREET ❑, 601 S 31ST ST CITY RENTON ST WA 2jp, 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 ✓ I iNTERLOCKYEs NO NTERLOCKYEs NO✓ YES R No 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� BLT4573 sTArI WAurN# 1GNSKBEOODR237037 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FR.. To TRLR. TRLR 4 8 33 12 0 0 VIN#' VIN# 2013 CHEV TAHOE SW Va ❑ RO�34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE 13 2 DAMAGE YES NO ✓ YES NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2007324841 <�O, IN EFFECT &POLICY#VEHICL CHARGE 36 LECALLv res❑NO CITATION#15❑ STAIN.D'ING UNIT VE IMOTOOR CYCLE ❑ PEDESTRIAN ❑ P PERTY ❑ DER YES✓ NO OLDMET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY ELLENSBURG ST ZIP 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YEs❑NOF,/ 19 LLIICENS# STATE SEX U MMDDYY —�_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG g RESTR g EJECT '1 USE 9 CLASS 0 ❑ 21❑ LICENSE AZP9783 TAre WA VIN# 1J4GW48S64C395875 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ TRLR R 43 LR VIN#. N I #. VEH YEAR 2004 MAKE JEEP MODEL GRAND STYLE SW VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES✓ NO BANKERS YES NO✓ REGISTERED OWNER INFO JAMES HUCKABAY 1231 W UNIVERSITY WAY ELLENSBURG WA 98926 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP _ 'E""Le ❑ ,J� CITATION# CHARGE I BOTTOM LEGALLY YES N`L J 25 ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED19084 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13596 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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 1 traveling NW on S 27th PI. Road is curving downgrade, and covered with ice due to freezing rain. Unit 1 slides on ice, and strikes unit 2, parked unoccupied on north shoulder of road. Unit 2 slides into back end of unit 3, which is parked in driveway of 500 S 27th PI. Unit 2 continues to slide downhill on ice, striking unit 4, which is standing in roadway in front of 500 S 27th PI. Driver 1 Ortiz Alpista exited car, slipped, and fell on icy pavement. Ortiz Alpista transported to hospital with injured shoulder (caused by fall, not collision). I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 12-23-22 05:33 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 1212712022 1:18:55 PM BADGE OR ID# 5738 OR]# WA0171300 TIME POLICE DISPATCHED', 8:26 AM TIME POLICE ARRIVED',8:26 AM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED19084 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 22-13596 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 1 8 28 CARRIER NAME 3 CARRIER ADDRESS `❑ CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES IN ✓ 1 4 29 LAST NAME : UNKNOWN FIRST NAME MIDDLE INITIAL STREET 0 9 30 NFW AnDRFS CITY ELLENSBURG ST ZIP 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑NO❑ YES N DRIVER'S STATE I SEX U M 7 ��DVSYv' -❑ 2 ❑ LICENSE ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 USE CLASS INJURY 0 NATURE OF INJURIES 8 ❑ 1 1 2 32 LICENSE BGC3160 [TAT WA VIN# JTJGA31U740038603 ❑ PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 TRLR TRLR 91 VIN.#. VIN.#. 11 O O VEH.YEAR2004 MAKE LEXS MODELRX 300 1 STYLE SW I VEHICLE TOWE E T SABLIN TOWED BY anvi vEH1C P FROM TO DAMAGE YES NO ✓ YES NO ✓ 33 12 REGISTERED OWNER INFO.ZACHARY VAN ZANDT 500 S 27TH PL RENTON WA 98055 D:2064468547 m 2 $ SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE[] INSURANCE CO R,i"01 9 9 IN EFFECT &POLICY# 13 ❑ LEGALLY ❑ ❑ CITATION# CHARGE BbTTUM 34 LEGALLY YES NO STANDING 7 ❑ ✓❑ PEDAL ❑ ❑ PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 14 2 UNIT# 4 VEO IOC E CYCLE PEDESTRIAN OWNER YES✓ NO D:2067104952 N:2069921559 15 ❑ TRAN KlM MIDDLE p 36 ❑ LAST NAME FIRST NAME. INITIAL 2 STREET 16 ❑ ❑ 10811 2ND AVE SW CITY SEATTLE ST WA ZIP 98146 N�n+AnntxFSS CDL❑ GNITION EN MEDICALTANSPORTEDNITION RRE INTERLOCK YEs NO✓ EsN 17 GERLOCK YESE N ✓ ❑ DRIVER'S D.O.B 5 37 LICENSE# STATE WA SEX M .D,O B Y' 11 - 16 - 1963 18 ❑ ❑ON DUTY STATUS' AIRBAG 2 RESTR. 4 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES 38 USE CLASS 19 ❑ LICENSE ❑ PLATE# CCB0846 TAr WA v!N# 5J6RE4H7XAL077440 39 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ [441 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE 2010 HOND CR-V EX SW DAMAGE vEs ✓No GENE MEYER YEs NO ✓ 23 ❑ REGISTERED OWNER INFO OWNED BYDRIVER SHADE IN DAMAGED AREA 43 LIABILITY INSURANCE INSURANCE CO THE CINCINNAP/NSURANCE COMPANYA01 106652 ❑ VEHICLE EFFECT &POLICY# g 44 24 LE LE ALE LLY YESZ NO❑ CITATION# CHARGE 4;k�j .STANDING a 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 12-23-22 05:33 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORRID# 5738 O#IL WA0171300 JOHNSON 12127/202 PAGE❑OF❑ 3000-345-013(R 11118) REPORT NO.! ED19084 CASE# 22-13596 DATE AND TIME 12/23/22 08:23 OF COLLISION 500 S 27th PI 0 t16 F- 4 'w S 27th PQt°'.. PAGE 4 OF 4