HomeMy WebLinkAbout23-2802 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
CASE 23-2802 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF; M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 03 - 08 - 2023 1936 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK NO. e --- ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MORR/S AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063357087 0 11
30
6❑ LAST NAME WILSON FIRSTNAME CHRISTOPHER MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 10437 65TH AVE S CITy SEATTLE ST WA 2jp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX' ID
M MELO B 10 1- 12 - 1993 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10❑ P1 ATE 14 BXK0146 STATE WA u N# 1 G6DV57V280175320
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 2 ZOO8 CADI CTS SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VawcLe CHARGE 1 5 36
ALLv re5 NO CITATION# 3AO171724 OP MOT VEH W/OUT INSURANCE o eorroM
15❑ �STA""
G 8 7 6
MOTOR PEDAL-:. 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069490623
16 a
LAST NAME TUBBS FIRST NAME ZORKA MIDDLE
INITIAL
17 STREET NEW ADDREs7 20915 262ND AVE SE CITY MAPLE VALLEY ST WA ZIP 98038 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK yEs I I NOF YEs t l NOF,/
19 LICENSE STATE WA SEX F MMDDYY 09 _ 10 _ 1942 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# ABV6492 TATE 41
WA VIN# 2T2BK16AXAC055282 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2010 MAKE LEX$ MODEL RX 300 STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO STATE FARM 019 6635-CO5-47GIN STOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 0( ' 6 i o BOTTOM
LEGALLY YES N`L J
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED41394
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2802
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MENDOZA ALEXANDERI
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
2101 SW SUNSET BLVD APT F206 RENTON WA 98057 2063357514 SEX M MMDOYyry 01 - 19 - 2010
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑: 1 POS. 3 2 4 1 USE 2 CLASS +1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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 03-08-23 10:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 311112023 12:27:21 AM
BADGE OR ID# 12489 OR]#' WA0171300 TIME POLICE DISPATCHED! 7:36 PM TIME POLICE ARRIVED',7:38 PM
PART I PAGE IT]OF 4�
REPORT NO. ED41394 CASE# 23-2802 OF COLLISION
03/08/23 19:36
OF CbLLI510N
NARRATIVE
CASE 23-2802
SECTOR CITATION: 3AO171724
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 March 8th, 2023, at approximately 19:38, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of S 3rd St and Morris Ave S in the City of Renton, King County,
Washington.
***CALL REMARKS: 2 MVC, BLOCKING, AID DECLINED. BLOCKING EB ON 3RD ... WHI LEXS
AND MARR CADI SEDAN.
-UNIT ONE: MAROON 2008 CADILLAC CTS WASHINGTON LICENSE BXK0146
-UNIT ONE DRIVER: CHRISTOPHER L. WILSON (DOB: 10.12.1993)
-UNIT TWO: WHITE 2010 LEXUS RX WASHINGTON LICENSE ABV6492
-UNIT TWO DRIVER: ZORKA TUBBS (DOB: 9.10.1942)
1 arrived on scene and contacted Christopher who was out of his car pointing at Zorka who was
stopped in the middle of intersection. Christopher reported the following; he was traveling south on
Morris Ave S and claimed Zorka ran the red light and crashed into him in the intersection. Christopher
indicated he had the green light. Christopher was not injured and did not appear to be injured.
Christopher's front passenger identified as Alexander I. Mendoza (DOB:1.19.2010) indicated he was
sitting in the front passenger seat at the time of the collision but was not injured. Unit one had
damage to the front right wheel. Christopher was able to drive the vehicle from the scene and
indicated he would park it down the street.
After talking to Christopher, I contacted Zorka who reported the following; she was traveling east on S
3rd St and claimed she had the green light and crashed into unit one who ran the red light. Zorka was
the sole occupant in the vehicle at the time of the collision and claimed she was not injured. Zorka did
not appear injured and there was damage to the front left side of her vehicle. Zorka was able to drive
her vehicle away from the scene.
There were no independent witnesses on scene to state who in fact had the green light and who had
the red light.
Christopher indicated he did not have vehicle insurance. I issued him a traffic infraction for operating
vehicle without motor vehicle insurance RCW 46.30.020. 1 provided Christopher the citation on scene.
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 03.08.2023 at 22:00 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED41394 CASE# ' 23-2802 DATE AND TIME 03/08/23 19:36
OF COLLISION
Morris Ave S
NOT To SCALE
S 3rd St
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PAGE 4 OF 4