HomeMy WebLinkAbout23-542 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 23-542 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 01 - 1-- 2023 1146 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 80 00 FEET MILES e S B W e S 7TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063849905 0 81
30
6� LAST NAME BARNETT FIRSTNAME BRIAN MIDDLE A 1 1 2 31
INITIAL
STREET El 1506 30TH ST SE APT 208 CITY AUBURN ST I WA 7jp, 980028179 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 08 — 10 — 1985 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ PI aT�S1t BZW8758 sTAr� WAVIN# 3LN6t5A94JR628152
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 9 34
13 3 2018 LING MKZ P4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO BRIAN BARNETT 501824TH PL S SEATTLE WA 98108 D:2063849905 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6078440390 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063074456
LAST NAME CANLAS FIRST NAME CHRISTIAN MIDDLE I P
INITIAL
17❑ STREET ❑', 8501 S 112TH ST CITY SEATTLE ST WA ZIP 981783308 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M M .C... 10 _ 13 _ 1998 El 39
WELMET {NJURY NATURE OF INJURIES 40
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE 2 CLASS 6 NECK/BACK PAIN
21❑ LICENSE BQJ7024 TAre WA VIN1 1C4HJXFG6KW580688
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE JEEP MODEL WRANGL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JOSE VELAZQUEZ MORENO 18302114TH AVE E PUYALLUP WA 98374 D:2062570086 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE� &POINSURGY#E CO STATE FARM 4678493-DO3-47IN 1 5
VEHICLE CITATION# CHARGE GQ
LEGA YES[Z NC[:]25❑ LLY Js a
7Q"u,'
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TIBEAU 07691 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED25011
COLLISION REPORT III III III III III 111
1591972 CASE# 23-542
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VELAZQUEZ MORENO JOSE
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
18302 114TH AVE E PUYALLUP WA 98374 2062570086 SEXi F MMDDYyry 04 - 23 - 1997
SEAT AIRBAG 2 RESTR. q EJECT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS $ USE 2 CLASS 7 NECK BACK PAIN
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER []WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
23-542
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
V-1 stated that he was traveling northbound on Rainier Ave S in the left turn lane for west bound
travel on SW 7th St. V-2 stopped suddenly for a yellow signal light, and he struck V-2. V-2 stated
that they were northbound on Rainier Ave S in the same left turn lane. They were about four cars
back when the signal light turned yellow and vehicles in front of them stopped. They stopped and
were struck from behind by V-1. The driver and passenger of V-1 both stated that their necks and
backs hurt. The Renton Regional Fire Authority responded to the scene to examine them. No one
was transported via aid to the hospital.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Q. Tibeau 01/14/2023 1254 hours, Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
QUINT TIBEAU 01-14-23 01:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 111512023 4:00:08 AM
BADGE OR ID# 07691 OR]# ! WA0171300 TIME POLICE DISPATCHED 11:51 AM TIME POLICE ARRIVED'12:03 PM
PART I PAGE IT]OF 3�
REPORT NO. ED25011 CASE# ' 23-542 DATE AND TIME 01/14/23 11:46
OF COLLISION
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