HomeMy WebLinkAbout23-3444 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
CASE 23-3444 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
$
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 - 26 - 2023 1532 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK e✓ 500 ❑
4a❑ MILEPOST
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:2065125573 0 11
30
6❑ LAST NAME MONTALVAN FIRSTNAME RODRIGO MIDDLE D 1 2 31
INITIAL
STREET ❑ 701 SW 5TH CT B307 CITY RENTON ST WA ZIP 98057 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'M MID
-O B 10 1- 09 - 1969 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR I [NATURE OF INJURIES
4 EJECT 1 H U EET 2 1 INJURY CLASS ju BRUISE TO RIGHT FOREARM z❑
3
10❑ P1 ATNES# CCt 5228 sTAr WAV N# JTEHH2OV410031476
TRAILER STATE TRAILER STATE
11 2 5 PLATE# I PLATE# I I FROM To
TRLR. TRLR. 7 3 33
12 2 5 VIN#' VIN#I
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 1 2001 TOYT RAV4 SV DAMAGE YES NO YES❑ No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO PROGRESSIVE 957233378 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063841782
LAST NAME GASTELUM SERVIN FIRST NAME JOVAN MIDDLE
INITIAL
17 STREET I❑ s❑' 310 WHITWORTH AVE S CITY' RENTON ST WA ZIP 98057 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YYEEsI I I NoF YES t l NO�
19 LICENSE# STATE WA SEX M M D.C.B. O6 �_ 24 _ 1992 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BGU4812 TArE 41
WA VINI 1J4HASH136L615163 1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
TOWED BY Gov HI 44
VEH YEAR 2011 MAKE JEEP MODEL WRANGL STYLE $P DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO FIRST NATIONAL H2331409IN Cal
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 =ORAJEWSKI
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12399 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED45803
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3444
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. 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.
RAYMOND GORAJEWSK/ 03-26-23 05:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 312712023 2:07:05 AM
BADGE OR ID# 12399 OR]# WA0171300 TIME POLICE DISPATCHED; 3:34 PM TIME POLICE ARRIVED 3:35 PM
PART I PAGE IT]OF 5�
REPORT NO. ED45803 CASE# 23-3444 OF COLLISION
03/26/23 15:32
OF CbLLI510N
NARRATIVE
ASSIGNMENT/ARRIVAL
On 03/26/2023 at approximately 1534 hours, I was dispatched to a two-vehicle traffic collision at the
intersection of S 3rd Street and Morris Avenue S in the city of Renton, King County, Washington.
I arrived at approximately 1535 hours.
UNIT 1: TOYOTA RAV4
Upon arrival I observed a white Toyota Rav4 (WA/ CCL5228, Unit 1) stopped in the intersection of S
3rd Street and Morris Avenue S, on all four wheels, facing southeast. Unit 1 had moderate front end
damage to the front, passenger side.
UNIT 2: JEEP WRANGLER
I observed a black Jeep Wrangler (WA/ BGU4812, Unit 2) on the southeast corner of S 3rd Street
and Morris Avenue S rolled on its driver side. Unit 2 nearly struck a City of Renton traffic signal. Unit 2
had moderate damage to the rear passenger wheel.
DRIVER 1: MONTALVAN, RODRIGO D.
I contacted Rodrigo D. Montalvan (DOB: 10/09/1969) sitting on the curb near Unit 2. 1 identified
Montalvan by his valid Washington Driver License. I established Montalvan as the driver of Unit 1 by
his admission.
INJURIES: MONTALVAN, RODRIGO D.
Montalvan had a large bruise to his right forearm.
The Renton Fire Authority responded and evaluated Montalvan on scene.
DRIVER 2: GASTELUM SERVIN, JOVAN
I contacted Jovan Gastelum Servin (DOB: 06/24/1992) standing near Unit 2. 1 identified Gastelum
Servin by his valid Washington Driver License. I established Gastelum Servin as the driver of Unit 2
by his admission.
INJURIES: GASTELUM SERVIN, JOVAN
Gastelum Servin's left elbow was red from the collision.
The Renton Fire Authority responded and evaluated Gastelum Servin on scene.
STATEMENT: MONTALVAN, RODRIGO D.
I spoke with Montalvan about the collision. The following is a summary of our recorded conversation:
Montalvan drove Unit 1 east on S 3rd Street in the number 1 lane (closest to south curb) toward
Morris Avenue S at approximately 40 miles per hour. Montalvan believed the traffic signal was green,
indicating for him to enter the intersection. As Unit 1 entered the intersection, Unit 2 drove south on
Morris Avenue S into the intersection, colliding with Unit 1's front end.
Montalvan was not sure the condition of the traffic signal, but "believed" it was green.
This concluded my conversation with Montalvan.
STATEMENT: GASTELUM SERVIN, JOVAN
I spoke with Gastelum Servin about the collision. The following is a summary of our conversation:
Gastelum Servin drove Unit 2 south on Morris Avenue S toward S 3rd Street at approximately 20
miles per hour. Gastelum Servin looked at the traffic signal and saw it was green, indicating for him to
enter the intersection.
As Unit 2 was in the intersection, Unit 1 entered the intersection from the west, driving eastbound on
S 3rd Street. Gastelum Servin swerved Unit 2 to the left (east), but was unable to avoid a collision.
Unit 1's front end collided with Unit 2's rear end, rolling the vehicle which came to rest on its driver
side.
PAGE 3 OF 5
REPORT NO. ED45803 CASE# 23-3444 OF COLLISION
03/26/23 15:32
OF CbLLI510N
NARRATIVE
Gastelum Servin had video of the collision from a dash camera mounted on Unit 2, but he was unable
to access it at the time.
This concluded my conversation with Gastelum Servin.
PHOTOGRAPHS
Officer J. Christiansen took photographs of the vehicles and the scene with her department issued
cell phone and uploaded the photographs to Axon's Evidence.com.
DISPOSITION
I was unable to determine the condition of the traffic signal when the vehicles entered the
intersection.
Both vehicles were towed away at the owners' request.
I gave both drivers an Exchange of Information form.
This concluded my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Officer R. Gorajewski, #12399, on 03/26/2023 at 1726 hours in Renton,
Washington.
PAGE 4 OF 5
REPORT NO. ED45803 CASE# ' 23-3444 DATE AND TIME 03/26/23 15:32
OF COLLISION
Morris Avenue S
N
Not to Scale
S$rd Street
PAGE 5 OF 5