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Home My WebLink About22-13079 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 22-13079 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 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION'. 12 - 11 - 2022 1453 17 ❑.❑ S 8 W H OF e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK NE SUNSET BLVD MILEPOST ST e✓ 1000 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 10 00 FMILES EET e S ❑ E e NE 10TH STREET 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2067794883 0 81 30 6� LAST NAME THURBER FIRSTNAME BRIAN MIDDLE L 1 2 31 INITIAL STREET ❑, 18543 SE 280TH ST CITY KENT ST WA ZIP, 98042 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ L NER # STATE yyq SEXI M MIDI Y' 09 - 09 - 1974 1 1 2 32 9� ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT '.9 HU 1 INJURY NATURE OF INJURIES EET 9 CLASS U BACKNECKPAIN z❑ 3 10❑ P1 ATE 14 B535974 STATE WA VIN# 5TBBT4415YS022345 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR $ 7 33 12 VIN#' VIN# ROM TO ❑ VEH.YEAR 2000 TOYT TUNDR 3C MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE J 13 9 34 4 DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14� INEFITYINSURANCE� INSURANCE CO USAACASUALY006978458C71015 4 LI EFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ No D:2068593933 N:2067789409 16 a LAST NAME VELASQUEZ ESPINAL FIRST NAME JOSE MIDDLE D INITIAL STREET CITY KENT ST ZIP 4 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVECEN # STATE SEX U M .C.B. 07 12 _ 2004 39 20 ON DUTY STATUS AIRBAG 2 RESTR 2 EJECT 1 H USE 2 LASSY 6 [NATURE OF INJURIES IUNCONSCIOUS ON ARRIVAL, NECK,BACK,LEG ❑ 40 41 21❑ PLATE# C35516Z TATE WA VIN# 1GCDK14KOLZ207985 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 1990 MAKE CHEV MODEL GSERIES STYLE TR VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44 24❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO MARCO TEMORES 1133 SW 139TH ST#249 BURIENWA 98166 VEHICLE NO.2 SHADE DAGELLCddAREA LIABILITY INSURANCE INSU PORGY#E CO USAA 00697 84 58C 7101 5 IN CTOP BOTTOM LEGALLY YES[Z Nu 25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 DES/REE SCOTT 10272 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED13818 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13079 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RUFINO ALMEJO E (LAST FIRST, ADDRESS&PHONE# D O.B. 2066410177 SEX MMDDYYYY 08 - 13 - 1994 PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES [:]WITNESS❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYYYV PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On 1 2/11/22 at 1453 hours I was dispatched to an injury collision located in the 1000 block of NE Sunset BLVD (City of Renton, County of King and State of Washington) Upon arrival 1 saw that it was a three car collision with Driver#2 unconscious and not responding. I went to Driver#2 and he had a pulse. Driver#2 was unconscious for several minutes. When he woke up he was unsure what had happened. Driver#2 told me he was stopped behind Driver#3 and the next thing he remembered was waking up to an Officer asking him if he was okay. Renton Fire Department checked out Driver #2. 1 contacted Driver#1 who said he was driving and saw that driver#2 was stopped and he tried to stop in time, but was unable to due to the slick wet roads and the rain. Vehicle #1 slid forwarded and struck Vehicle #2, pushing Vehicle #2 into Vehicle #3. Driver#1 had back and neck pain. Vehicle #1 had damage to its front bumper, hood and quarter panels and had to be towed by Bankers towing. Driver#2 companied of back, neck pain and had been found unconscious upon arrival. He declined to go to the Hospital via ambulance and stated that he would have a family member take him. Vehicle #2 had substantial damage to its rear window, was broken out, the bed of the pick up truck was pushed in and the front of the vehicle bumper, hood and quarter panels were all damaged. The vehicle was towed to Bankers. Driver#2 NVOL Driver#3 stated he was stopped at the light and vehicle #3 was struck from behind by Vehicle #2. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. DESIRES SCOTT 12-12-22 04:19 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIREE SCOTT 10272 12/12/2022 4:28:54 PM BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED 2:55 PM TIME POLICE ARRIVED',2:56 PM PART Ei PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED13818 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 22-13079 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES� NO D:2067887055 rFO 8 29 LAST NAME NC�UYEN FIRST NAME HUNG MIDDLE' V INITIAL STREET 30 NEW AnDRFSP' 1819 ELMA AVE NE CITY RENTON ST WA ZIP 98059 6 [2 1 1 2 31 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED INTERLOCK YEs NO zERLOCK YES❑N0� YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 06 - 19 - 1967 7 HELMET INJURY NATURE OF INJURIES ON DUTY STATUS AIRBAG'' 2 RESTR. 4 EJECT 1 USE 2 CLASS 7 BACK PAIN LICENSE I CCM2087 [TAT WA VIN# JM3KFBDM2N1586550 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2022 MAKE MAZD MODEL CX-5 SE STYLE P4 I VEHICLE TOME E T SABLIN TOWED BY anvi vFH1C P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOMICHELLE NGUYEN 1616 SHATTUCK AVE S RENTON WA 98055 J 9 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO PEMCO CA 1628854 R"i"Olx IN EFFECT &POLICY# 1 EHICLE 34 13 4 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTOM STANDING } 7 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME N DL 36 ❑ AL STREET 16 NFWAET [_% CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE rnr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. DESIREE SCOTT 12-12-22 04:19 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 10272 O#I',WA0171300 APPROVED BY 12112/202 PAGE F OF 4 3000-345-013(R 11118) REPORT NO.! ED13818 CASE# ' 22-13079 DATE AND TIME 12/11/22 14:53 OF COLLISION E 10TH', PAGE 4 OF 4