HomeMy WebLinkAbout23-6354 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-6354 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 06 - 1-- 2023 2320 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
2900 NE 10TH ST
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElDESA✓NHORESHOLDMET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
DRIVERS
STATE SEX D — 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ PI ATE 14 CBW9178 JBTATIJ WAv N# 1 NXBU40E39Z092111
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. YRLR. 8 4 33
12❑ VIN#1 VIN#
Rom 34
13❑ VEH.YEAR 2009 MAKE TOYT MODEL COROL STYLE VEHICLE TOWED NOO pLSSBLIN TQ yEkkRS yOS❑ENO
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO WILLIAM CABRERA TAMACAS 3030 NE 10TH STAPT409 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY#VEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <14,
15❑ STAIN.F-
UNIT 02 VE IOCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' Sr ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRES
ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES I I NOF YES t l NO❑
19 LLIICENS RIVEWS# STATE SEX MMDDYY —=_ 39
-----WELMET NATURE OF INJURIES 4O
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
LICENSE VIN# `1
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED68638
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6354
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'
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.
JAKE GALL 06-05-23 12:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 6/9/2023 2:44:16 PM
BADGE OR ID# ! 12617 ORI#' WA0171300 TIME POLICE DISPATCHED 11:23 PM TIME POLICE ARRIVED',11:30 PM
PART I PAGE IT]OF 4�
REPORT NO. ED68638 CASE# 23-6354 OF COLLISION
06/04/23 23:20
OF CbLLI510N
NARRATIVE
*This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. *
On 06/04/2023 at around 2323 hours, I was dispatched to a collision located at 2900 NE 10th PL for a
vehicle into a fence. I arrived on scene and located vehicle 1 (Silver 2009 Toyota Corolla bearing WA
LIC CBW9178) had crashed through a chain link fence and impacted a Jersey Barrier directly behind
the fence. Only once section of chain link fence was damaged, and the Jersey Barrier received zero
damage. The front of vehicle 1 near the driver's side suffered major damage. There was no airbag
deployment. The RO lives at 3030 NE 10th St, which was nearby. Officers were unable to locate the
RO of the vehicle at the residence. It is unknown if the RO was the driver of the vehicle at the time of
the collision.
There was no evidence inside the vehicle which would lead me to believe that the driver was under
the influence.
Bankers Tow arrived on scene and took possession of the vehicle.
I left a business card with the case number at the construction site of 2900 NE 10th St for the
damaged chain link fence. Google Maps says the construction site is Renton Housing Authority.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Gall/12617
06/5/23 at 0021 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. ED68638 CASE# 23-6354 DATE AND TIME 06/04/23 23:20
OF COLLISION
Cola
—Not to,sca$e M:l
2900 N E 1Oth St
u
PAGE 4 OF 4