HomeMy WebLinkAbout23-912 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z3-s12 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 7 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# ❑
GawsloN 01 - 1-- 2023 1907 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S ❑ W e RANTER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063077470 30
6❑ LAST NAME WILLIAMS FIRSTNAME BROOKE MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 236 24TH AVE E APT#B CITY SEATTLE ST I WA 7jp, 98112 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # . STATE WA SEX'F MID
.O B 10 - 23 - 1987 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� AWH3843 sTArI WAvIN# JTDKDTB37C1506994
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 2 34
13 1 2012 TOYT PRIUS HB DAMAGE vesNo ves❑ No
REGISTEREDOWNERWFO BROOKE WILLIAMS 23624TH AVE EAPT#BSEATTLEINA98112 D:2063077470 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NPOLICY E CO PROGRESSIVE 949955429 4
LI EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2063037435
16 a
LAST NAME PICH FIRST NAME CHHOY MIDDLE J
INITIAL
17 STREET NEW ADOREs7 4509 S ASOTIN ST CITY TACOMA ST WA ZIP 98418 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 D IVEW #
ON DUTY STATUS 3 AIRBAG RESTR EJECT H EET 2 NJAURSY 6 [NATURE OF INJURIES
TRANSPORTED TO HOSPITAL ❑ 40
❑21❑ LICENSE TArE 41
VIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED By Gov HI 44
L4 Q $ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I VE'LLe ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N J
s � e
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 1 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED31202
COLLISION REPORT III III III III III 111
1591972 CASE# 23-912
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SCOTT BYNOE EULA L
(LAST FIRST,
ADDRESS&PHONE#
1709 26TH AVE SEATTlE WA 98122 2063345182 SEXi F MMDOYyry 11 - O6 - 1984
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 PC& 3 2 4 1 USE 2 CLASS I1
NAME
'(LAST,FIRS MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER [:]WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
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.
BRYAN GROZAV 01-21-23 09:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 2/4/2023 4:17.30 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 7:09 Pry TIME POLICE ARRIVED',7:11 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED31202 CASE# 23-912 OF COLLISION01/21/23 19:07
NARRATIVE
CASE 23-0912
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Saturday January 21st, 2023, at approximately 19:15, 1 responded to a 911 call regarding a
collision involving a pedestrian in the 100 block of S 3rd St in the City of Renton, King County,
Washington.
***CALL REMARKS: VEH VS PED. **ON S 3RD ST IFO LOC, PT IS CONSC. PT COMPLIAING OF
LEFT SHOULDER PAIN, ADV. ELSON, EVELYN/PSRBY...503/481-5054...1 AGO, MALE "PASSED
OUT" IN ROAD BETWEEN CASINO AND SAFEWAY, OTHERS HELPING HIM, LINK FURTHER, RP
NO LONGER AT LOC.
-PEDESTRIAN: CHHOY J. PICH (DOB: 7.05.1996)
-UNIT TWO: BLLCK 2012 TOYOTA PRIUS WASHINGTON LICENSE AWH3843
-UNIT TWO DRIVER: BROOKE M. WILLIAMS (DOB: 10.23.1987)
When I arrived on scene, there were several other officers already on scene. I was informed by
Officer A. Collins that he was told Chhoy crossed the street in front of a car and was hit by unit two. I
contacted Brooke who said she was driving east on S 3rd St when Chhoy walked in front of her
vehicle and wasn't able to stop in time. Brooke was not injured but was examined by Renton Fire
personnel.
Chhoy was still on the ground when I arrived being triaged by Renton Fire personnel. He was alert
and conscious able to tell me his name and his mother's phone number. Chhoy was later transported
to Valley Medical Center for his injuries.
I provided Brooke a business card with the case number.
This concludes my involvement in this case.
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 B. Grozav #12489 on 01.21.2023 at 21:10 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED31202 CASE# ' 23-912 DATE AND TIME 01/21/23 19:07
OF COLLISION
NOT TO SCALE
PAGE 4 OF 4