HomeMy WebLinkAbout23-3437 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3437 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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 03 - 1-- 2023 1300 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N 10TH ST BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FMILES EET e S ❑ E e LOGAN AVE N
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2063344842 0 11
30
6❑ LAST NAME BERAKI FIRSTNAME MERON MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 11901 85TH AVE S CITY SEATTLE ST WA ZIP 981784032 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 06 1- 25 - 1972 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aTES� ADG8139 sTArI WAurN# JTDBR32E552066340
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR 2005 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 3 7 TOWED BY GOVT.VEHICLE 34
13 4 TOYT COROL DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO MERONS.RA.1190185THAVE S SEATTLE WA 98178 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GRANGE INSURANCE 5104440044206 3 4
IN EFFECT &POLICY# 9TOP
15
vEGAEHA"LE 5 36
LLLY re8�No M CITATION# 3A0111453 CHARGE INATTENTIVE DRIVING )o eorrom
❑ STANDING 8 7 6
MOTOR PEDAL-:. 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4254204281
16 a
LAST NAME ORTIZ GUZMAN FIRST NAME KENIA MIDDLE
INITIAL
17 STREET I❑ s❑' 510 STEVENS AVE SW APT 0104 CITY' RENTON ST WA ZIP 980572370 4❑ 37
NEW ADDREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK yyEEsl I I NOF YES
t l No�
19 LICENSE# STATE WA SEX F M.C... 03 _ 13 _ 2002 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# A6156051 TArE 41
WA VIN# 2T3DF4DVSBW174660 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2011 MAKE ]'DY)' MODEL RA V4 STYLE $W DAMAGE TOWED TOO✓ BLIN YES
NO,/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 963842631IN 1UR
VEHICLe ❑ ,.II CITATION# CHARGELEGALLY YES N J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED52144
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3437
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 03-26-2023 at about 1304 hours, I was dispatched to a collision which took place in the 700 block
of N 10th St, City of Renton, King County, Washington.
Unit 1 WA License plate: ADG8139 Driver: Beraki, Meron S (06-25-1972)
Unit 2 WA License plate: A6156051 Driver: Ortiz Guzman, Kenia (03-13-2002)
Both drivers were identified via WADLs.
Driver of unit 1 informed me that he was coming out of the driveway and making a left turn merging
onto N 10th St. He said he checked and there were no cars. When he made his left turn he struck
the other vehicle. He insists he checked and it was clear to make a turn.
Driver of unit 2 said she was in lane 2 approaching the intersection of N 10th St and Logan Ave N
when unit 1 came out of the driveway and struck her vehicle.
Driver of unit 1 was cited for inattention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 04-17-23 09:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 411712023 5:42:59 PM
BADGE OR ID# 10065 OR]# WA0171300 TIME POLICE DISPATCHED! 4:04 Pry] TIME POLICE ARRIVED 1:11 PM
PART I PAGE IT]OF
REPORT NO. ED52144 CASE# ' 23-3437 DATE AND TIME 03/26/23 13:00
OF COLLISION
NOT TO SCALE
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