HomeMy WebLinkAbout24-1198 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-11s8 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
Ct ELISION' 02 - 01 - 2024 1806 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 90 00 FMILES EET e S ❑ E e ANACORTES AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064981640 0 81
30
6� LAST NAME OLIVIANO FIRSTNAME LEONILA MIDDLE M 1 2 31
INITIAL
STREET ❑, 1018 OLYMPIA AVE NE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES 1/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑
USE CLASS j I HEAD PAIN,CHEST PAIN,NECK PAIN
3
10 8❑ Pl AT 14 ABD7774 STATE WA VIN#' 1 NXBU40E99Z051420
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 7 33
12 3 5 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 4 2009 TOYT COROL SD DAMAGE YES No � �MEYER'S TOWING ves❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 IN EF IT INSURANCE ALLSTATE 987575954
IN EFFECT &POLICV# TOPVEHlcl.e CHARGE <1�3
OTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:6025611932
16 a
LAST NAME RAMIREZ FIRST NAME ERICK MIDDLE IM
INITIAL
17❑ NEW STREETR 650 DU
7 VALL AVE NE#P1223 CITY RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE AZ SEX M I D.C... 07 O6 _ 1983 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR g EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CDV8074 TATE 41
WA VIN# JTNKHMBXXL1082199 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2020 MAKE TOYT MODEL C-HR STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CHARLENE ROBINSON 650 DUVALL AVE NE#P1223 RENTONWA98059 D:6027961855 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO PROGRESSIVE 960124416IN I STOP
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES NEI
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
NATHANIEL BROWN 12765 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE47402
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1198
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 stopped east of Anacortes Ave NE in lane #2 of westbound NE Sunset Blvd at a stable red
light. Unit 1 was traveling in lane #2 of westbound NE Sunset Blvd. The light just turned from a stable
red to green. As unit 2 began to drive forward with traffic, unit 1 struck unit 2 from behind at an
unknown rate of speed, causing severe damage to the front end of unit 1 and minor damage to the
rear end of unit 2. Unit 1 was unable to move under its own power and was towed from the scene.
Unit 2 was driveable. The driver of unit 1 had suspected head, neck, and chest injuries and was
transported to Overlake hospital. There was airbag deployment. The driver of unit 2 was uninjured. It
is unknown how or why the driver of unit 1 was distracted and why they did not slow down their
vehicle for traffic. The driver of unit 1 failing to slow down for traffic is the proximate cause of this
collision.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Traffic Control: STABLE RED LIGHT TURNED GREEN
Motor Vehicle Unit 2
Traffic Control: STABLE RED LIGHT TURNED GREEN
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NATHANIEL BROWN 02-01-24 07:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 21512024 6:53:07 AM
BADGE OR ID# 12765 ORI# WA0171300 TIME POLICE DISPATCHED', 6:11 PM TIME POLICE ARRIVED',6:17 PM
PART I PAGE IT]OF
REPORT NO. EE47402 CASE# ' 24-1198 DATE AND TIME 02/01/24 18:06
OF COLLISION
1 Xti.
j
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