TRAFFIC COLLISION REPORT Page 1 of 4 SPECIAL CONDITIONS SFTA NUMBER INJURED HIT & RUN FELONY CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER 2 GARDEN GROVE WEST ORANGE 15-003193 LFTA NUMBER KILLED HIT & RUN MISDEMEANOR COUNTY REPORTING DISTRICT BEAT 0 ORANGE 44 1-1 MO / DAY / YEAR TIME (2400) NCIC # OFFICER I.D. COLLISION OCCURRED ON: KNOTT ST. 03/07/2015 1037 3009 4049 DAY OF WEEK TOW AWAY PHOTOGRAPHS BY NONE AT INTERSECTION WITH: S M T W T F S YES NO STATE HWY REL OR : YES NO PARTY DRIVER©S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE 1 A4968640 CA C M G 2011 TOYOTA CAMRY GRAY 6PGW237 CA DRIVER NAME (FIRST, MIDDLE, LAST) MARION MARIE HOWELL OWNER©S NAME CITY OWNED SAME AS DRIVER PEDES- STREET ADDRESS TRIAN OWNER©S ADDRESS SAME AS DRIVER 889 VICTOR AVE #4 PARKED CITY STATE ZIP DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER VEHICLE INGLEWOOD CA 90302 CITIZEN REQUEST AAA BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE CLIST MO DAY YEAR F BRN BRN 509 150 05 07 1967 BLACK OTHER HOME PHONE BUSINESS PHONE EXT VEHICLE IDENTIFICATION NUMBER: 4T1BF3EK9BU172411 (310)897-6604 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK NONE MINOR 01 GEICO 4367295625 MOD MAJOR ROLLOVER DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT X X N KNOTT ST. CAL-T TCP/PSC MC/MX PARTY DRIVER©S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE 2 X0591590 CA N/A M G 2000 PONTIAC GRAND WHITE 7BRJ985 CA DRIVER NAME (FIRST, MIDDLE, LAST) GERSON MARTINEZ OWNER©S NAME CITY OWNED SAME AS DRIVER PEDES- STREET ADDRESS TRIAN OWNER©S ADDRESS SAME AS DRIVER 628 E. 53RD STREET PARKED CITY STATE ZIP DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER VEHICLE LONG BEACH CA 90805 P.D. TOW GREATER SO CAL BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE CLIST MO DAY YEAR M 02 04 1992 HISPANIC OTHER HOME PHONE BUSINESS PHONE EXT VEHICLE IDENTIFICATION NUMBER: 1G2NF52E6YC512113 (562)388-1079 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK NONE MINOR 01 X ACCESS ACA003252985 MOD MAJOR ROLLOVER X DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT X N KNOTT ST. CAL-T TCP/PSC MC/MX PARTY DRIVER©S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE DRIVER NAME (FIRST, MIDDLE, LAST) OWNER©S NAME CITY OWNED SAME AS DRIVER PEDES- STREET ADDRESS TRIAN OWNER©S ADDRESS SAME AS DRIVER PARKED CITY STATE ZIP DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER VEHICLE BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE CLIST MO DAY YEAR OTHER HOME PHONE BUSINESS PHONE EXT VEHICLE IDENTIFICATION NUMBER: VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK NONE MINOR MOD MAJOR ROLLOVER DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT CAL-T TCP/PSC MC/MX OFFICER NAME & I.D. REVIEWER©S NAME DATE REVIEWED A. HERNANDEZ 4049 W. ALLISON 0121 03/07/2015 NARR. PASS. WIT. CSI STORED VEH. RPT. P& E OTHER TRAFFIC COLLISION CODING Page 2 of DATE OF COLLISSION TIME (2400) NCIC # OFFICER I.D. NUMBER 03/07/2015 1037 3009 4049 15-003193 OWNER©S NAME OWNER©S ADDRESS NOTIFIED PROPERTY YES NO DAMAGE DESCRIPTION OF DAMAGE City Property Damage SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS M / C BICYCLE-HELMET A - CELLPHONE HANDHELD A - NONE IN VEHICLE L - AIR BAG DEPLOYED DRIVER PASSENGER B - CELLPHONE HANDSFREE B - UNKNOWN M - AIR BAG NOT DEPLOYED V - NO X - NO C - ELECTRONIC EQUIPMENT C - LAP BELT USED N - OTHER W - YES Y - YES D - RADIO / CD D - LAP BELT NOT USED P - NOT REQUIRED E - SMOKING 1 - DRIVER E - SHOULDER HARNESS USED F - EATING 2 TO 6 PASSENGERS F - SHOULD HARNESS NOT USED CHILD RESTRAINT EJECTED FROM VEHICLE G - CHILDREN 7 - STATION WAGON REAR G - LAP/SHOULDER HARNESS USED Q - IN VEHICLE USED 0 - NOT EJECTED H - ANIMALS 8 - REAR OCC. TRK. OR VAN H - LAP/SHOULDER HARNESS NOT USED R - IN VEHICLE NOT USED 1 - FULLY EJECTED I - PERSONAL HYGIENE 9 - POSITION UNKNOWN J - PASSIVE RESTRAINT USED S - IN VEHICLE USE UNKNOWN 2 - PARTIALLY EJECTED J - READING 0 - OTHER K - PASSIVE RESTRAINT NOT USED T - IN VEHICLE IMPROPER USE 3 - UNKNOWN K - OTHER U - NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (*) SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(#) OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 3 SPECIAL INFORMATION 1 2 3 COLLISION 1 A VC SECTION CITED A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL A STOPPED VIOLATED YES VC 21801 (A) NO B CONTROLS NOT FUNCTIONING* B CELL PHONE HANDHELD IN USE B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING* C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN C RAN OFF ROAD USE D NO CONTROLS PRESENT / FACTOR* D CELL PHONE NOT IN USE D MAKING RIGHT TURN C OTHER THAN DRIVER* TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN* A HEAD - ON F 75 FT MOTORTRUCK COMBO F MAKING U TURN B SIDE SWIPE G 32 FT TRAILER COMBO G BACKING C REAR END H H SLOWING / STOPPING WEATHER (MARK 1 TO 2 ITEMS) D BROADSIDE I I PASSING OTHER VEHICLE A CLEAR E HIT OBJECT J J CHANGING LANES B CLOUDY F OVERTURNED K K PARKING MANEUVER C RAINING G VEHICLE / PEDESTRIAN L L ENTERING TRAFFIC D SNOWING H OTHER* M M OTHER UNSAFE TURNING EFOG / VISIBILITY FT. N N XING INTO OPPOSING LANE F OTHER* MOTOR VEHICLE INVOLVED WITH O O PARKED G WIND A NON - COLLISION P MERGING LIGHTING B PEDESTRIAN Q TRAVELING WRONG WAY A DAYLIGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTOR(S) R OTHER* 1 2 3 B DUSK - DAWN D MOTOR VEHICLE ON OTHER (MARK 1 TO 2 ITEMS) CITED C DARK - STREET LIGHTS ROADWAY A VC SECTION VIOLATED YES D DARK - NO STREET LIGHTS E PARKED MOTOR VEHICLE NO CITED E DARK - STREET LIGHTS NOT F TRAIN B VC SECTION VIOLATED YES FUNCTIONING* G BICYLE NO SOBRIETY - DRUG ROADWAY SURFACE H ANIMAL: C VC SECTION VIOLATED CITED 1 2 3 PHYSICAL YES (MARK 1 TO 2 ITEMS) A DRY NO B WET I FIXED OBJECT: A HAD NOT BEEN DRINKING C SNOWY - ICY J OTHER OBJECT: D B HBD - UNDER INFLUENCE D SLIPPERY (MUDDY, OILY, ETC) E VISION OBSCUREMENT C HBD - NOT UNDER INFLUENCE* ROADWAY CONDITIONS PEDESTRIAN©S ACTIONS F INATTENTION* (MARK 1 TO 2 ITEMS) A NO PEDESTRIANS INVOLVED G STOP & GO TRAFFIC D HBD - IMPAIRMENT UNKNOWN* A HOLES, DEEP RUT* B CROSSING IN CROSSWALK H ENTERING / LEAVING RAMP B LOOSE MATERIAL ON AT INTERSECTION I PREVIOUS COLLISION E UNDER DRUG INFLUENCE* ROADWAY* C CROSSING IN CROSSWALK - NOT J UNFAMILIAR WITH ROAD F IMPAIRMENT - PHYSICAL* C OBSTRUCTION ON ROADWAY* AT INTERSECTION K DEFECTIVE VEH. CITED G IMPAIRMENT NOT KNOWN EQUIP.: YES D CONSTRUCTION - REPAIR D CROSSING - NOT IN CROSSWALK NO H NOT APPLICABLE ZONE E REDUCED ROADWAY WIDTH E IN ROAD - INCLUDES SHOULDER L UNINVOLVED VEHICLE I SLEEPY / FATIGUED* FFLOODED* F NOT IN ROAD MOTHER* GOTHER* G APPROACHING / LEAVING SCHOOL N NONE APPARENT H NO UNUSUAL CONDITIONS BUS O RUNAWAY VEHICLE SKETCH MISCELLANEOUS SEE NARRATIVE FOR DETAILS. INDICATE NORTH STATE OF CALIFORNIA INJURED / WITNESS / PASSENGERS Page 3 of 4 DATE OF COLLISION (MO. DAY YEAR) TIME (2400) NCIC# OFFICER I.D. NUMBER 03/07/2015 1037 3009 4049 15-003193 EXTENT OF INJURY ("X" ONE) INJURED WAS ("X" ONE) WITNESS PASSENGER AGE SEX PARTY SEAT SAFETY EJECTED ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP. INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER # 22 F 2 3-PAS G NO NAME / D.O.B. / ADDRESS TELEPHONE EXT TANIA BARAHONA 01/03/1993 628 E. 53RD ST #K LONG BEACH CA 90805 (562)388-1079 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: REFUSED DESCRIBE INJURIES COMPLAINT OF PAIN TO LEFT ARM AND LEFT LEG VICTIM OF VIOLENT CRIME NOTIFIED # 29 F 2 5-PAS G NO NAME / D.O.B. / ADDRESS TELEPHONE EXT RUTH UMANA 08/02/1985 653 E. 53RD ST LONG BEACH CA 90805 (562)200-1056 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED # 13 M 1 3-PAS G NO NAME / D.O.B. / ADDRESS TELEPHONE EXT FRANK STAINE 05/07/2001 889 VICTOR AVE #4 INGLEWOOD CA 90302 (310)897-6622 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED # 14 M 6-PAS NAME / D.O.B. / ADDRESS TELEPHONE EXT MARK BELL 01/24/2001 1518 W. 52ND ST INGLEWOOD CA 90805 (323)534-7127 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED # 1 75 M NAME / D.O.B. / ADDRESS TELEPHONE EXT CHARLES HAND 10/16/1939 1871 SKYLINE DR FULLERTON CA 92831 (714)871-4815 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED # 23 M 2 1-DR G NO NAME / D.O.B. / ADDRESS TELEPHONE EXT GERSON MARTINEZ 02/04/1992 628 E. 53RD ST #K LONG BEACH CA 90805 (562)388-1079 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: CARE WEST MED ANAHEIM DESCRIBE INJURIES COMPLAINT OF CHEST PAIN, BACK PAIN, NECK PAIN, AND PAIN IN BOTH KNEES VICTIM OF VIOLENT CRIME NOTIFIED # NAME / D.O.B.