HomeMy WebLinkAbout23-8144 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED80080 170
27
COLLISION REP FIT 1591971
CASE 23-8144 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 1 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 07 - 1-- 2023 1214 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON EXT S BLOCK NO. e✓ 13200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S.132 ST
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065789837 0 11
30
6� LAST NAME BYRANT FIRSTNAME THOMAS MIDDLE 1 2 31
INITIAL
STREET ❑ 425 SOUTH TACOMA WAY CITY TACOMA ST WA 2jP, 98042 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 3 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ PICENS11 ATE 14 1 G6RDS7Y770184624 STATE WA u N# 1 G6RDS7Y770184624
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 1 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 $ 34
13 4 2007 CADI DTS P4 DAMAGE YES NO � g MYERS YES❑ NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2018429894 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068539309
16 a
LAST NAME TEOFILO RIVERA, FIRST NAME NOE MIDDLE
INITIAL
17 STREET❑ NEW ADDRESS❑' 11840 SE 184TH ST CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 05 _ 05 _ 1986 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 9 RESTR 4 EJECT 1 HELMET 2 I PAIN
NJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS BACK NECK
❑21❑ PLATE# C58094S TATE 41
WA vIN1i 3C6UR5DL5KG608644 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE DODG MODEL RAM STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MYERS YES NO
REGISTERED OWNER INFO NOE TEOFILO-RIVERA,11840 SE 184THST RENTON WA 98058 D:2068539309 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 817255061IN IGQ"'LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED80080
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8144
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TEOFILO VASQUEZ NOE
(LAST FIRST,
ADDRESS&PHONE#
11840 SE 184 ST RENTON WA 98056 SEX M MMDDYyvv 05 - OS - 1986
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT H USE 2 INJURY 1 NATURE OF INJURIES
❑✓ ❑, 2 POS. 11 9 4 1
NAME
(LAST,FIRST,MIDDLE INITIAL) CREACH SAMMY R
ADDRESS&PHONE# D O B
6909 S 123RD ST#148 SEATTLE WA 98178 2067349067 SEX F MMnDYvvv 03 _ O6 _ 2002
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 7/26/23 around 1214 hours I was dispatched to the intersection of 13200 block of Renton AVE
EXT (City of Renton, County of King, and State of Washington) due to a report of a vehicle collision.
Upon arrival I contacted Driver#1 who stated he was going South bound on S. 132 ST that merges
into Renton AVE EXT. Driver#1 said he merged to far over and went into the wrong lane striking
vehicle #2. Vehicle #1 sustained extensive damage to the front quarter panel, wheel, hood, and
bumper. Driver#2 stated he was headed south bound on Renton AVE EXT when Vehicle #1 merged
and went too far over striking the front passenger side of Vehicle #2. Vehicle #2 had damage to its
front bumper, wheel, both doors and quarter panel. Driver#2 complained of neck and back pain.
Passenger#2 did not report any injuries. Driver#1 did not report any injuries. Witness stated the
same as both Driver#1 and Driver#2 Both vehicles were towed by Gene Myers towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
DESIRES SCOTT 07-16-23 02:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 711612023 2:32:31 PM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED; 12:18 PM TIME POLICE ARRIVED 12:25 PM
PART I PAGE 2�OF❑
REPORT NO. ED80080 CASE# ' 23-8144 DATE AND TIME 07/16/23 12:14
OF COLLISION
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