HomeMy WebLinkAbout23-3839 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-3839 2 0 5
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 04 - 1-- 2023 1326 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PUGET DR SE BLOCK NO. e✓ p
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e ROLLING HILLS DR SE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064372323 0 11
30
6� LAST NAME BAKER FIRSTNAME CEAVIONNA MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 12210 SE PETROVITSKY RD APT 7 C{Ty RENTON ST I WA 2jp, 980586626 2
NEW ADDRESS
]❑ 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 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� A6176574 sTArr WAurN# 3FA6P0RU4GR196682
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 3 ] 34
13 2 2016 FORD FUSION DAMAGE vEs 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
2 INSURANCE CO 4
14 LIABILITY INSURANCE NATIONAL GENERAL 2018035053
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE tOBOTTOM 5 36
YES No CITATION# 3A0179190,3A0179190 FAIL YIELD LEFT TURN MOTOR
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064878120
a
LAST NAME LUNA FIRST NAME RUBY MIDDLE E
INITIAL
17❑ STREET ❑', 16201 121 ST AVE SE CITY' RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C... 08 _ 01 1996 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AGF5117 TAre 41
WA VIN# 1GBDV13W77D143009
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2007 MAKE CHEV MODEL UPLANDS STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24 DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO GABRIEL ALVAREZ 16201121STAVE SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT �-I &POLICY# 1 0 BOTTOM
9TOP 5
VEHICLE YES[:] NC CITATION# 3AO179191 CHARGE OP MOT VEH W/OUT INSURANCE
LLY
25 ' ai
LEGA —
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED48960
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3839
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ALVAREZ RICO SERGEIO G
(IAST FIRST,
ADDRESS&PHONE#
16201 121ST AVE SE RENTON WA 98056 2064879922 SEX M MMDDYyvv 09 - 28 - 1990
PASSENGER I�I WITNESS R',UNIT# ', 2 POS 3 AIRBAG 3 RESTR. 4 EJECT ? 1 H U EET 2 CLASS '1 NATURE of INJURIES
NAME L�1
(LAST,FIRST,MIDDLE INITIAL) ALVAREZ GABRIEL P
ADDRESS&PHONE# D O B
16201 121ST AVE SE RENTON WA 98058 2064097523 SEX M MMDDvvvv 02 _ 27 _ 1963
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 5 AIRBAG 9 RESTR. 2 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 2 was traveling westbound on Puget DR SE approaching Rolling Hills DR SE with the right of
way. Unit 1 was in the center turn lane traveling eastbound on Puget DR SE intending to turn left
onto northbound Rolling Hills DR SE. Passenger in Unit 2 (Sergio) stated he observed driver 1 on
her cell phone. Driver 1 stated she was working for an internet food delivery service and while her
phone was on, it was on a holder on the dashboard. Driver 1 stated that she thought Unit 2 was far
away and began her turn failing to yield the right of way to Unit 2. Unit 1 pulled into the path of Unit 2
and the front end of Unit 2 impacted the front passenger side of Unit 1 causing moderate/heavy and
disabling damage to both vehicles.
Driver 1 cited for failing to yield the right of way to a motor vehicle by turning left in front of Unit 2
which had the right of way and was the proximate cause of the collision.
Driver 1 also cited for operating a telecommunication device while driving based on Passenger
(Sergio)'s statement that he observed her on the phone.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-04-23 03:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 4/6/2023 10:11:21 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 1:31 PM TIME POLICE ARRIVED:1:36 PM
PART I PAGE IT]OF
REPORT NO. ED48960 CASE# ' 23-3839 DATE AND TIME 04/04/23 13:26
OF COLLISION
ROLLING HILLS DR SE
—NOT TO SCALE"„ w
c�
a
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