HomeMy WebLinkAbout23-8560 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8560 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 3
HIT 8 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# ❑
cowsloN 07 - 1-- 2023 1501 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 2000
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2537364849 0 11
30
6 LAST NAME CRISOSTOMO MEDINA FIRST NAME JOSE MIDDLE A 1 2 31
INITIAL
STREET ❑✓ 850 HARRINGTON AVE NE#8 CITy RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs No�/
8❑ LRIIVER # STATE WA SEX'M MI D Y' 05 - 15 - 1993 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE CER8749 sTATI WA urN#' 1N4AL2AP7AN562121
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 2 2010 NISS ALTIMA DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO VALENTINE CRISOSTOMO BAUTISTA 230 SW 146TH ST BURIEN WA 98166 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VEwcLE CHARGE 10BOTTOM 5 36
-ALLY YES No CITATION# 3A0402372,3A0402372, NEGLIGENT DRIVING 2ND DEGREE,
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:4252130851
16 a
LAST NAME SWANBERG FIRST NAME DAVID MIDDLE W
INITIAL
17❑ STREET ❑', 466 FERNDALE AVE NE CITY' RENTON ST WA ZIP 980564010 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t l NOF,/
19 F] STATEWASEXM .C.B. 04 � _ El 39
LICENSE# M
H USE ET LAU Sy ANKLE,KNEE,F—NATURE OF AND HAND INJURY 40
20 ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 2 6
21❑ LICENSE AVT7513 TATe WA VIN# JF1ZCAC14F9604279
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE SUBA MODEL BRZ STYLE VEHICLETOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES 11
REGISTERED OWNER INFO DAVID SWANBERG 466 LEAVE NE RENTONWA98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO STATEFARM 055711OD1247DIN CQl
VEwGLE ❑ ,J� CITATION# CHARGE i o
LEGALLY YES N`L J
25
7KLANE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED85547
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8560
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TOMPSON MARCUS T
(LAST FIRST,
ADDRESS&PHONE#
1167 REPUBLICAN ST APT 305 SEATTLE WA 981095557 2066410181 SEX M MMDOYyry 01 - 08 - 1974
PASSENGER WITNESS # SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
�✓ UNIT POS. ' USE .CLASS +
NAME
'(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
K.LANE 07-26-23 04:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 12:54:49 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 3:04 PM TIME POLICE ARRIVED 3:07 PM
PART I PAGE IT]OF 4�
REPORT NO. ED85547 CASE# 23-8560 OF COLLISION
07/26/23 15:01
OF CbLLI510N
NARRATIVE
Unit 1 was traveling eastbound in the 2000 blk of NE Sunset BLVD in the left (north) inside lane. Unit
2 was traveling westbound in the 2000 blk of NE Sunset BLVD in the left (south) inside lane. This
portion of roadway has a gradual curve which is right hand of eastbound traffic and left hand for
westbound traffic. For unknown reasons, Unit 1 failed to negotiate this curve and traveled straight
ahead as the roadway curved to the right. Unit 1 crossed over the center line and entered the lane
Unit 2 occupied. The front end of Unit 1 struck the front end of Unit 2 striking head on at speed.
Heavy damage sustained to the front end of both vehicles with heavy mechanism. Driver 2 sustained
injuries to his ankles, knees, and cuts and injury to both hands. Driver 1 appeared uninjured. Both
vehicles towed by Bankers tow.
Driver 1, who was Spanish speaking only, relayed through a friend that he lost control and was
unable to turn Unit 1. Driver 1 relayed that the vehicle did not have insurance, and that he did not
have a drivers license. DOL records check showed that Driver 1 was "NOT LICENSED-eligible" and
did not have a valid drivers license.
Driver 1 was cited for negligent driving 2nd degree by negligently operating a motor vehicle by driving
without a drivers license and not negotiating a turn properly resulting in the vehicle crossing over the
center line at 35mph+ and striking another vehicle head on.
Driver 1 was also cited for NVOL 2nd by operating a motor vehicle without a valid operators license,
with ID, as well as operating a motor vehicle without insurance.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: CROSSING OVER CENTER LINE STRAIGHT AHEAD
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. ED85547 CASE# ' 23-8560 DATE AND TIME 07/26/23 15:01
OF COLLISION
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