HomeMy WebLinkAbout23-1625 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-1625 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cowsloN 02 - 08 - 2023 1641 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF GARDEN AVE N
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066876343 0 11
30
6❑ LAST NAME RICHARDSON FIRSTNAME KAYETTA MIDDLE I M 1 1 2 31
INITIAL
STREET ❑ 5710 E ROOSEVELT AVE CITY TACOMA ST WA ZIP 98404 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICENS DRIVER # STATE WA SEX'F MMDDYY 11 — 02 — 1958 K2
32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ �i aE'rES� BMV7813 sTATe WA urN# 2HGFC1F70GH636937
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. A'RLR. 1 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2016 HOND CIVIC SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN 3 7 TOWED BY GOVT.VEHICLE 34
13 4 DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 4559984788 4
LI EFFECT I SUR N# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4255246508
16 1
LAST NAME SOTO CORDOVA FIRST NAME LUIS MIDDLE A
INITIAL
17 NEW STREETR 7' 212 S 49TH ST UNIT B CITY RENTON ST WA ZIP 98055 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 WA SEX M D.C.B. 10 _ 28 _ 1976 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLATE# CDW9649 TATE WA VIN# JHMCM56733C086814 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2003 MAKE HOND MODEL ACCORD STYLE $D —7EHICLE
TOWED✓ NOO BLIN GENE MYERES YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 5231034132947IN 1 VE-LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED35371
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1625
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
PM 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'
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 02-08-23 08:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 2/19/2023 7:59:30 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED', 4:44 PM TIME POLICE ARRIVED]4:46 PM
PART I PAGE IT]OF 4�
REPORT NO. ED35371 CASE# 23-1625 OF COLLISION
02/08/23 16:41
OF CbLLI510N
NARRATIVE
CASE 23-1625
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 Wednesday February 8th, 2023, at approximately 16:44, 1 responded to a 911 call regarding a two
-vehicle collision at the intersection of Park Ave N and Bronson Way N in the City of Renton, King
County, Washington.
'CALL REMARKS: 2 MVA... NO INJ... BLOCKING MIDDLE OF INTERSECTION.
-UNIT ONE: SILVER 2016 HONDA CIVIC WASHINGTON LICENSE BMV7813
-UNIT ONE DRIVER: JAYETTA M. RICHARDSON (DOB: 11.02.1958)
-UNIT TWO: SILVER 2003 HONDA ACCORD WASHINGTON LICENSE CDW9649
-UNIT TWO DRIVER: Luis A. SOTO CORDOVA (DOB: 10.01.1994)
1 arrived on scene and contacted Jayetta who said she was taking a left turn onto Bronson Way N
from Park Ave N. She checked cross traffic and proceeded through the intersection to complete her
turn but crashed into unit two. Jayetta was almost through the intersection when the collision
occurred. Jayetta indicated traffic was stopped on Bronson Way N, so she thought it was safe to
proceed through intersection. Unit two was traveling in the left lane and she did not see unit two
approached because traffic was stopped. Jayetta was not injured, and her vehicle had front end
damage. Jayetta was able to move her vehicle out of the intersection, but her vehicle was not drivable
due to the air bags being deployed.
After talking to Jayetta, I contacted Luis who was said unit one pulled out in front of him while
traveling west on Bronson Way N. Luis was examined by EMS personnel on scene. Unit two was
towed from the scene due to its damages and not being drivable.
I provided all involved parties a copy of the SECTOR exchange of information form.
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 02.08.2023 at 19:05 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED35371 CASE# ' 23-1625 DATE AND TIME 02/08/23 16:41
OF COLLISION
Park Ave. N. NOT TO SCALE
N. 1st St
Bronson Way N.
PAGE 4 OF 4