HomeMy WebLinkAbout23-2631 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2631 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 03 - 1-- 2023 1436 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE SE BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066979650 0 11
30
6� LAST NAME MAMALLO FIRSTNAME JUSTIN MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 1303 S FOREST ST CITY SEATTLE ST WA 2jp, 98144 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET ICNLJU:SY 0 NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 922PBS STATE WA VIN#' JHLRE487X7C032581
TRAILER STATE TRAILED STATE
11 3 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 5 33
12 3 0 VIN#' VIN#
>;. FROM TO
VEH.YEAR 2007 HOND CRV UT MAKE MODEL STYLE VEHICLE TOWED TO BLIN T YMEYERS GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No � YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO USAA 025730427G 3 4
IN EFFECT &POLICY# 9TOP
❑ LEGALLYE LE CHARGE 1 5 36
15 2 YEs No clTAnoN# 3A0018954 FAIL YIELD LEFT TURN MOTOR s 10 aorrom
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063698215
16 a
LAST NAME HAYNES FIRST NAME MARCI MIDDLE /
INITIAL
17❑ STREET ❑', 12835 163RD AVE SE CITY RENTON ST WA ZIP 98059 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l No❑
19 RRS LDIIVE STATE WA ]SEX IF M .C.B. 04 25 _ 1959 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BUH2864 TATe WA VIN1t KM8K1CAA8KU287934
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2019 MAKE yyUN MODEL KONA STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 927323189IN 1UQ,
VE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
=KI
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED39645
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2631
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'
On Saturday, March 4, 2023 at 1438 hours, I was dispatched to a two-vehicle collision in the area of
the 800 block of Union Ave NE.
The following occurred within the City of Renton, King County; Unit 1 - WA/ 922PBS was being
driven by Justin Mamallo and was driving from NE 8th St onto northbound on Union Ave NE. Unit 2 -
WA/ BUH2864 was driven by Marci Haynes and was travelling sorthbound on Union Ave NE in the
800 block. Justin stated he was turning left onto Union Ave NE from NE 8th St when he thought he
was clear of traffic but was not and caused Unit 2 to brake quickly. Marci stated she was unable to
avoid colliding with Unit 1. The front bumper of Unit 2 crashed into driver's side of Unit 1. Unit 1 failed
to yield while making a left turn which resulted in a collision.
Both vehicles sustained damage and only Unit 1 needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 03-04-23 04:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 3/5/2023 5:44:02 PM
BADGE OR ID# 12598 ORI# WA0171300 TIME POLICE DISPATCHED 2:38 PM TIME POLICE ARRIVED 2:43 PM
PART Ei PAGE IT]OF
REPORT NO. ED39645 CASE# ' 23-2631 DATE AND TIME 03/04/23 14:36
OF COLLISION
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UNIT
POINT OF IMPACT
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