HomeMy WebLinkAbout22-13115 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED13823 170
27
COLLISION REP FIT 1591971
CASE 22-13115 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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#
COLLISION 12 - 12 - 2022 0600 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MILEPOST
N 3RD ST BLOCK
4a❑ e✓ p ❑
O.
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e MEADOW AVE N
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064878630 0 11
30
6� LAST NAME URRUTIA FIRSTNAME DANIEL MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 702 W CASINO RD,APT Y101 CITY EVERETT ST WA Zjp, 98204 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES z❑
USE CLASS HEAD PAIN,HAND LACERATION
3
10 9❑ Pl QEES# C16227N STATE WA VIN#' 1FTZR15V6XTB05321
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. YRLR. 5 3 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 3 34
13 1 1999 FORD RANGE PK DAMAGE YES NO �LIkRS ves❑ No
REGISTERED OWNER INFO DANIEL URRUTIA 702 W CASINO RD,APT Y101 EVERETT WA 98204 D:2064878630 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 INSURANCE CO 3 4
14 LIABILITY INSURANCE NATIONAL GENERAL 2010276657
IN EFFECT &POLICY# 9TOP
❑ VE—LE CHARGE 10BOTTOM 5 36
15 2 LEGALLY res No CITATION# 2A0557161 FAIL YIELD AT YIELD e 5
w'
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' ❑ PEDESTRIAN ❑ OWNER ❑ YES,/ NO D:2536783835
16 2
LAST NAME PETERSON FIRST NAME HOLLY MIDDLE IM
INITIAL
17❑ NEW STREETREs7 21014 SE 271 ST ST CITY COVINGTON ST WA ZIP 98042 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.O.B. 12 _ 20 _ 1973 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BEP9003 TATE 41
WA vIN# 1FM5K8GT7FGC40382 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2015 MAKE FORD MODEL EXPLORE STYLE I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO HOLLY PETERSON 21014 SE 271ST ST COVINGTON WA 98042 D:2536783835 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE 8 POINSURGY#E CO ALLSTATE 976366360IN CQl
'E""LE ❑ ,J� CITATION# CHARGE io
LEGALLY YES N`L J
25
7NE
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ON 12327 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED13823
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13115
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.
T.NELSON 12-12-22 07:23 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1211212022 4:29:02 PM
BADGE OR ID# 12327 ORI# WA0171300 TIME POLICE DISPATCHED 6:11 AM TIME POLICE ARRIVED',6:17 AM
PART Ei PAGE IT]OF 4�
REPORT NO. ED13823 CASE# 22-13115 OF COLLISION
12/12/22 06:00
OF CbLLI510N
NARRATIVE
22-13115
On 12-12-2022 at approximately 0611 hours I was dispatched N 3rd St and Meadow AVE N, in the
City of Renton, County of King, WA for a collision.
I arrived and located unit 1 which was on the sidewalk on the southeast corner of the aforementioned
intersection. Unit 1 had sustained damage to the front driver side bumper. Unit 2 was on N 3rd St in
lane 1, just east of Meadow AVE N. Unit 2 had sustained damage to the front passenger side
bumper.
I contacted the driver of unit 2, Holly. Holly advised that she was travelling east on N 3rd St in lane 1
when unit 1 pulled out in front of her and she struck unit 1. Holly said she did not have time to stop or
maneuver her vehicle to avoid striking unit 1.
I contacted the driver of unit 1, Daniel. Daniel relayed a similar account of the collision and stated that
unit he did not see unit 2 when he attempted to turn onto N 3rd St from Meadow AVE N.
My observations of the position of both vehicles and the damage was consistent with what both
drivers advised.
The fire department arrived and evaluated Daniel for head pain and a minor laceration to his hand.
Daniel was medically cleared by fire on scene.
Both vehicles were inoperable and were towed by Bankers Towing.
There is a stop sign on Meadow AVE N at N 3rd St, therefore traffic on N 3rd St has the right of way.
Based on my observations of the scene and what each driver advised, I gathered that Daniel's failure
to yield the right of way was the proximate cause of the collision.
Daniel was cited for violating of RCW 46.61.190 by failing to properly yield the right of way at a stop
sign.
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 T. Nelson #12327 on 12-12-2022 0706 hours Renton, WA
PAGE 3 OF 4
REPORT NO.! ED13823 CASE# 22-13115 DATE AND TIME 12/12/22 06:00
OF COLLISION
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