HomeMy WebLinkAbout23-346 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE RESULTED ❑ CASE 23-346 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DArE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 01 - 09 - 2023 1528 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S LANGSTON RD BLOCK NO. e✓ 8000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ W❑ S 134TH ST
2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067866231 30
6 LAST NAME VILLA GONZALEZ FIRST NAME JESUS MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 616 SHATTUCK AVE S#A CITY RENTON ST WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 1 HELMETUSE 2 1 INJURY]CLASS 6 [NATURE OF IN DRIES
LACERATION TO FACE z❑
❑P1 ATE 14 CFD2754 STATE WA VIN# 1 HGEJ1125SL021955 3
10❑
TRAILER STATE TRAILER STATE
11 2 5 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
FROM
34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE
13 2 1995 HOND CIVIC CP DAMAGE YES NO MEYERS YES[:] NO✓
REGISTERED OWNER INFO LUIS MERAZ GO.LEZ 1206 THOMAS LN APT 5 RENTON WA 98055 D:2067866231 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 6'eIOP
VEwcLE CHARGE BOTTOM 5 ❑ 36
EGALLY YES No CITATION# 3A0055429,3AO055429 OP MOT VEH W/OUT INSURANCE,NO
15❑ STANDING 7 6
MOTOR
❑ PROPERTY ❑
PEDAL- PHONE
UNIT 02 VEHICLE PEDESTRIAN ❑
CYCLE OWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs❑NOF YES❑No❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TATE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED26463
COLLISION REPORT III III III III III 111
1591972 CASE# 23-346
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) AGUIRRE HERNANDEZ ARTURO
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
2333 15TH AVE S SEATTLE WA 98144 2066654866 SEX M MMDOYyvv 07 - 15 - 2005
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑'UNIT# 1 POS. 3 AIRBAG i 2 RESTR. 9 EJECT USE 2 CLASS 6 LACERATION TO FACE
NAME
(LAST,FIRST,MIDDLE INITIAL) GUZZONE LOREN D
ADDRESS&PHONE# D O B
16122 42ND AVENUE CT E TACOMA WA 984463069 2533703235 SEX' M MMnDuvvv O6 _ O6 _ 1962
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[:]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
MATTHEW NUGENT 01-11-23 02:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 111912023 12:44:32 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 3:30 PM TIME POLICE ARRIVED',3:37 PM
PART I PAGE IT]OF 4]
REPORT NO. ED26463 CASE# 23-346 OF COLLISION
01/09/23 15:28
OF CbLLI510N
NARRATIVE
23-346
On 01/09/2023 at 1530 hours, I was dispatched to a vehicle versus utility pole collision at the
intersection of S Langston Rd and S 134th ST within the City Limits of Renton, County of King, State
of Washington.
While en route, Dispatch advised that Renton Fire had simultaneously been dispatched due to a
utility pole having been involved.
Upon arrival, I observed the driver of Unit#1 standing outside of his vehicle was blocking both lanes
of travel on S Langston Rd. The only involved vehicle had struck a utility pole which apparently
caused a power outage to the area. I requested through Dispatch that Puget Sound Energy be
notified for response. The driver and passenger of Unit#1 were actively being treated for a facial
injury by Renton Fire. Both were released at the scene.
The driver of Unit#1 stated he and his passenger were traveling east in about the 13400 block of S
Langston Rd approaching the intersection of S 134th ST. The driver of Unit#1 stated that the brakes
on his vehicle became defective and that he was unable to slow his vehicle. The driver of Unit#1
stated his vehicle went off the roadway and subsequently struck a utility pole before coming to a rest
in the roadway.
A witness, identified via WADL as Loren Guzzone, stated he saw the vehicle lose control and strike
the utility pole. Guzzone confirmed the driver of Unit#1 as the same one who identified himself as the
driver to me (Villa Gonzalez). Guzzone also stated that the front bumper of Unit#1 came detached
and flew into the front of the witness's vehicle. The witness later corrected the placement of where the
bumper hit his vehicle which was actually to the rear driver side fender.
Unit#1 suffered significant damage to the front and underneath the vehicle as a result of the collision.
Unit#1 was moved off the roadway and was privately impounded due to extensive damage.
I cited the driver of Unit#1 (Villa Gonzalez) for NVOL-with ID even though Villa Gonzalez did not
have an actual form of identification on him and could have been criminally cited. I verified Villa
Gonzalez's identity via DOL photo match. I also cited Villa Gonzalez for Operating a Motor Vehicle
without insurance. I gave Villa Gonzalez a very warning for Speed Too Fast for Conditions.
The vehicle owner and witness were provided an exchange of information.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 1/10/2023 10:50 AM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED26463 CASE# ' 23-346 DATE AND TIME 01/09/23 15:28
OF COLLISION
f
*Diagram not to scale
Unit#1
S 134th ST S 134th ST
a
'V itnes;s
PAGE 4 OF 4