HomeMy WebLinkAbout22-13225 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 22-13225 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
cowsloN 12 - 1-- 2022 1611 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MONTEREYAVE NE BLOCK NO. e ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV a NE 3RD STREET
1 6 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254359327 0 81
30
6� LAST NAME MENDOZA FIRSTNAME CONSUELO MIDDLE 1 2 31
INITIAL
STREET ❑ 627 LYONS AVE NE CITY RENTON ST WA ZIP 980594827 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10❑ P1 ATE 14 AZW8923 STATE WA VN# 2T3RFREV1GW464371
TRAILER STATE TRAILER STATE
11 1 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 1 5 VIN#j VIN#
:: FROM TO
VEH.YEAR 2016 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 9 9 34
13 4 TOYT RAV4 UT DAMAGE YES NOBS YYES[:] No✓
REGISTERED OWNER INFO ROMINA HALILI 627 LYONS AVE NE RENTON WA 98059 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO ALLSTATE 917084899 <��34
IN EFFECT &POLICY#VEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION#
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2062147261
16 a
LAST NAME HOZDIC FIRST NAME ARMIN MIDDLE N
INITIAL
17❑ STREET NEW ADDREss❑' 3521 S 160TH ST APT A2 CITY SEATAC ST WA ZIP 981882638 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVEW # STATE I WA SEX M M D.C.B. 11 01 1979 39
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 HEJ EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ ILICENSE PLATE# BQW4941 TATE WA vIN1 WDDGF8A61DR280756 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE MERZ MODEL C300 4D STYLE SO VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO ARMIN HOZDIC 300 VUEMONTPL NEAPT U104 RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE❑ &POINSULICY#E CO NONE N/AIN C(5 Q16
—e E CITATION# CHARGE LGALYYES Nu25❑
7MICAELA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 CASTAIN 7 12573 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED31406
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13225
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
PM 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAELA CASTAIN 12-14-22 05:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 2/5/2023 6:35:08 PM
BADGE OR ID# 12573 OR]# WA0171300 TIME POLICE DISPATCHED; 4:11 PM TIME POLICE ARRIVED',4:11 PM
PART I PAGE IT]OF 4�
REPORT NO. ED31406 CASE# 22-13225 OF COLLISION
12/14/22 16:11
OF CbLLI510N
NARRATIVE
Unit 1: Consuelo Mendoza (DOB 03/22/1954), 2016 Gray Toyota Rav 4 (WA/AZW8923)
Unit 2: Armin Hozdic (DOB 11/01/1979), 2013 White Mercedes C300 (WA/BQW4941)
On 12-14-2022 at approximately 1611 hours I drove by a collision that recently occurred at the
intersection of Monterey Dr NE and NE 3rd Street, in the City of Renton, King County, WA.
Upon arrival, I contacted both parties. Both parties appeared to have no injuries. Renton Fire
appeared on scene because of an air bag deployment in Unit 2.
Both parties agreed on what occurred during the collision.
Unit 1 was traveling in lane 2 westbound on NE 3rd Street, through the intersection and collided with
Unit 2 head on. Unit 2 was stopped at the light eastbound on NE 3rd Street, in the left turn lane at the
light. Unit 1's light was green and Unit 2's light was a flashing yellow arrow.
Unit 1 advised she fell asleep while operating her vehicle and woke up when she realized she
collided with Unit 2. Unit 1 advised she did not take any medications and was not under the influence
of alcohol or drugs.
Unit 2 appeared alert and did not show any signs of being under the influence of alcohol or drugs.
Both vehicles were towed by Bankers Towing.
I gave both parties an exchange of information sheet.
Based on the statements made from both parties, the proximate cause for this incident is Unit 1.
This concludes my involvement with this case.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Castain #12573 12/14/2022 Renton, King County, WA
PAGE 3 OF 4
REPORT NO. ED31406 CASE# ' 22-13225 DATE AND TIME 12/14/22 16:11
OF COLLISION
Bronson Way N
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