HomeMy WebLinkAbout23-14336 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE34925 170
27
COLLISION REP FIT 1591971
CASE 23-14336 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
cawsloN 12 - 1-- 2023 0614 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e LOGAN AVE S
2 0 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 1 30
6 LAST NAME RODULFO SANCHEZ FIRST NAME ABRAHAM MIDDLE J 1 2 31
INITIAL
STREET ❑, 1412E 29TH ST CITY TACOMA ST WA ZIP 98404 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYES NO INTERLOCK YES NO YES No
8❑ DRIVER'S STATE SEX'U D.o.6. 02 - 21 - 2000 1 2 32
LICENSE# MMDI3YY
9 ON DUTY❑ STATUS' AIRBAG 4 RESTR 2 EJECT 1 N USEET CLASRSY 7 N PURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� A685137 sTArI WAurN# 5NPDH4AE3GH733703
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 7 34
13 1 2016 HYUN ELANTR DAMAGE YES NO �LAWkkRS YES❑ No
REGISTEREDOWNERINFO ROSNEIVYS SEQUERA ACOSTA 1412E29THST TACOMA WA 98404 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE❑ IN CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe 1 5 36
LECALLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258947454
16 a
LAST NAME MILNER FIRST NAME SHANNON MIDDLE I B
INITIAL
17❑ STREET ❑', 4525 S 256TH ST CITY' KENT ST WA ZIP 980329754 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO❑
19 LICENSE# STATE WA SEX F M.C... 10 _ 17 1972 0 39
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BDL6840 TAre WA VINIi 2GNFLGEK7H6115077
❑ 41
PLATE#
El 42
22 R TILER❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2017 MAKE CHEV MODEL EQUINOX STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SHANNON MILNER 4525 S 256TH ST KENT WA 980329754 D:4258947454 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#ECO STFARML085959AO347JIN IGQI
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE34925
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14336
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.
M.LEVERTON 12-14-23 07:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/28/2023 7:10:34 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 6:14 AM TIME POLICE ARRIVED',6:17 AM
PART I PAGE IT]OF 4�
REPORT NO. EE34925 CASE# 23-14336 OF COLLISION
12/14/23 06:14
OF CbLLI510N
NARRATIVE
BLUE SUV LANE 3 GOLD SWDAN/1 SWERVE
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash at about the 600 block of s 2nd
St.
I contacted the driver of unit 2 who told me she was in lane 3 when unit 1 swerved into the side of her.
She told me she emergency braked but contact was happening. She wasnt sure why she was hit by
unit 1. She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1. He did not speak any English and provided me with a passport from
Venezuela. A unknown female assisted with translation. She explained that unit 1 made several
lane changes and struck unit 2. He did not have a drivers license in the US or in South America.
There was no insurance on the car he was driving. He was not the RO and the car was totaled. He
did complain of a possible hip injury but refused treatment on scene. Bankers impounded the sedan.
Information/Insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 12/14/2023
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REPORT NO. EE34925 CASE# 23-14336 DATE AND TIME 12/14/23 06:14
OF COLLISION
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