HomeMy WebLinkAbout23-1872 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
CASE 23-1872 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 RESERVATION STRUCK
z
3❑ DATE dF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 02 - 1-- 2023 1323 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE 172ND ST BLOCK NO. e✓ 10900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 109TH PL SE
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:6199498557 0 11
30
6� LAST NAME TELLO FIRSTNAME LUIS MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 10930 SE 172ND ST#G205 CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
❑ DRIVER'S' STATE CA SEX'M MD-O B 03 1- 30 - 1993 2 32
8 LICENSE#
9 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS INJURY
1 NATURE OF INJURIES 2❑
❑ 3
10 9❑ P1 ATE 14 CFD4644 STATE WA VIN# 2C3CDXCTXKH584328
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2019 DODG CHARG DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LUIS TELLO 10930 SE 172ND ST APT G205 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 963345247 3 4
IN EFFECT &POLICY# 9TOP
CITATION# CHARGE
5 36
15❑ vFEGHrACL.LEY YES❑NO❑ INATTENTIVE DRIVING
STANDING 8 7 6
MOTOR PEDAL- :.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5038059097
16 a
LAST NAME MANNING FIRST NAME LEEANTHONY MIDDLE M
INITIAL
17❑ STREET ❑', 1220 SW 66TH AVE#2314 CITY PORTLAND ST' OR ZIP 97225 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE OR SEX M I D.O.B. O6 _ 26 _ 1995 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE 527NDN TATE 41
OR VIN1 YV1LT56D9X2587268
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 1999 MAKE VOLV MODEL S70 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO DANIEL TAYLOR 5275 NE 15TH AVE UNITA PORTLANDOR97211 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# IUQ,
5VEHICLE YEs N� CITATION# 3A0195449,3AO195450 CHARGE OP MOT VEH W/OUT INSURANCE,LEGALLY25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# FENCY26K.LANE 10008 A0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED35844
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1872
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'
Unit 2 was traveling eastbound on SE 172nd ST approaching 109th PL SE with the right of way. Unit
1 was traveling southbound in an apartment complex driveway at SE 172nd ST directly across from
109th PL SE planning to turn right westbound onto SE 172nd ST. Unit 1 failed to yield the right of
way to Unit 2 as the vision was blocked by parked cars and Driver 1 stated he didn't see Unit 2.
Driver 1 did not exercise due care and caution and pulled out onto SE 172nd ST without assuring it
was clear and the front end of Unit 1 struck the front driver's side of Unit 2. Unit 2 sustained disabling
front wheel damage and Unit 2 sustained moderate front end damage. Unit 2 was towed by Bankers
Tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 02-15-23 04:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 212112023 9:56:35 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 1:27 Pry TIME POLICE ARRIVED'1:36 PM
PART I PAGE IT]OF
REPORT NO. ED35844 CASE# ' 23-1872 DATE AND TIME 02/15/23 13:23
OF COLLISION
DRIVEWAY TO APT C
AV ENER
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