HomeMy WebLinkAbout23-116 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z3-11s 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 01 - 1-- 2023 1433 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
DUVALL AVE NE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e NE 24TH ST
❑ �
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4256631283 0 11
30
LAST NAME LOPEZ-FERNANDEZ FIRST NAME DEYANIRA MIDDLE
6 INITIAL 1 2 31
STREET ❑ 1150 UNION AVE NE APT 10-3 CITY RENTON ST I WA 2jp, 980594425 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ P1 ATE 14 CFE9149 STATE WA V N# 4T1 BF1FKXHU764038
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN If VIN#
>VI FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 2 2017 TOYT CAMRY DAMAGE YES ZNO �LII� RS YES❑ No
REGISTERED OWNER INFO MA—FERNANDEZ GARCIA 1150 UNIONAVENEAPT 10-4 RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE INSURANCE CO STATE FARM 5265685-D13.47 3 4
IN EFFECT &POLICY# 9TOP
vEHICLE CHARGE 5 36
LE ALLr re6 No clTAnoN# 3A0087425 FAIL YIELD AT YIELD o aorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258666333
16 a
LAST NAME KAUR FIRST NAME PRABHJEET MIDDLE
INITIAL
17❑ STREET ❑', 1074 ILWACO PL NE CITY' RENTON ST WA ZIP 980594369 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YES❑NOF,/
19 LICENSE# STATE WA SEX F M .C... 11 04 1998 El 39
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE 2 CLASS NOSE PAIN ❑
21❑ LICENSE I CDX0215 TATE I WA YIN# JTDK820U863153511
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2006 MAKE 7'Dy7- MODEL pRIUS STYLE —TEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 959909422IN I STOP 5
VEHICLE ❑ ,.I— CITATION# CHARGE to BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED21834
COLLISION REPORT III III III III III 111
1591972 CASE# 23-116
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 was stopped at a stop sign on eastbound NE 24th ST at Duvall AVE NE intending to turn left
onto northbound Duvall AVE NE. Unit 2 was traveling southbound on Duvall AVE NE approaching
NE 24th ST with no traffic control and with the right of way. Unit 1 failed to yield this right of way at
the stop sign to Unit 2 and entered the intersection making the left-hand turn and into a collision
course with Unit 2. The front end of Unit 1 struck the front passenger corner of Unit 2 causing
moderate/heavy damage to both vehicles. Driver 2 complained of nose pain but declined AID. Both
vehicles towed by Bankers Tow.
Driver 1 cited for failure to yield the right of way at a stop sign/intersection by being stopped at a stop
sign and proceeding forward not yielding the right of way to Unit 2 which was the proximate cause of
the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 01-03-23 03:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1/4/2023 12:51:36 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 2:35 PM TIME POLICE ARRIVED';2:41 PM
PART I PAGE IT]OF
REPORT NO. ED21834 CASE# 23-116 DATE AND TIME 01/03/2314:33
OF COLLISION
***NOT TO SCALE***'
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