HomeMy WebLinkAbout23-9721 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED92665 170
27
COLLISION REP FIT 1591971
CASE 23-9721 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 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#
cowsloN 08 - 1-- 2023 1444 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV e PARK AVE N
0 3 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE O 3 30
6� LAST NAME GARCIA FIRSTNAME ANTONINO MIDDLE S 1 1 2 31
INITIAL
STREET ❑, 1614 169TH ST CT S CITY SPANAWAY ST WA Zjp, 98387 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8 LRIIVERCENS # STATE SEX'U MDMDo 06 - 13 - 1978 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES z❑
3
LICENSE CDK9625 sTArI WAVrN# 5J6YH28583L032599
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 7 34
13 2 2003 HOND ELEMEN SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO ANTONINO GARCIA 1614169TH ST CT S SPANAWAY WA 98387 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3
LIABILITY INSURANCE
IN EFFECT &POLICY# � 9TOP 5
vewcLE CHARGE 10 BOTTOM 36
EGALLv YES No CITATION# 3A0635198,3A0635198 IMPROPER LANE USAGE,OP MOT
15❑ STANDING 8 7 6
UN�T MOTOR PEDAL-:. ❑ :PEDESTRIAN PROPERTY ❑ DAM THR OLD MET PHONE
02 VEHICLE CYCLE OWNER
16 2
LAST NAME WILSON FIRST NAME GABRIELLE MIDDLE M
INITIAL
17❑ STREET ❑', 1823 HARRINGTON AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YEs t l NO❑
19 LICENSE# STATE WA SEX U M.C.B. 12 _ 21 1996 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE A6585666 TAre WA VIN# 1N46L4EV8LC163113
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE NISS MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO GABRIELLE WILSON 1823 HARRINGTON AVE NE RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VE"LE ❑ Nu,J CITATION# CHARGE
25 io BOTTOM
LEGALLY YES ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SlTIVEN/TAMAIVENA 12812 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED92665
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9721
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
PM 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.
S/TIVENI TAMAIVENA 08-23-23 04:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 8/25/2023 4:00:54 AM
BADGE OR ID# 12892 OR]# ! WA0171300 TIME POLICE DISPATCHED 2:45 PM TIME POLICE ARRIVED 2:49 PM
PART I PAGE IT]OF 4�
REPORT NO. ED92665 CASE# 23-9721 OF COLLISION
08/23/23 14:44
OF CbLLI510N
NARRATIVE
unit 2 black sedan lane 1 and green unit 1 lane 2 crossed over
CC
Within city limits of Renton/King/WA I responded to a two car crash at the intersection of Park Ave N
at Bronson Way N.
I contacted the driver of unit 2 who told me that she was in lane 1 making a right turn from Park to
Bronson. She said she could see unit 1 drifting into her lane she slowed but unit 1 struck her vehicle
regardless. This was confirmed with a short video. Unit 2 did not complain of injury and damages did
not require a tow truck.
I contacted the driver of unit 1 ID'd by matching picture WADL. He told me she merged into his lane
and struck his vehicle and he tried to confirm this by pointing out the location of the damages of his
vehicle. He was unable to provide, In fact he told me he did not have any insurance he did not
complain any injury and damages did not require a tow truck.
I cited unit 2 driver ref RCW 46.61.140 improper lane usage causing a two car crash and ref RCW
46.30.020 no valid insurance via compliant.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
S.Tamaivena/12812 City of Renton/King/Wa 08/23/2023
PAGE 3 OF 4
REPORT NO. ED92665 CASE# ' 23-9721 DATE AND TIME 08/23/23 14:44
OF COLLISION
NTS M
,f
PAGE 4 OF 4