HomeMy WebLinkAbout23-3420 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED47092 170
27
COLLISION REP FIT 1591971
CASE 23-3420 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 N E IN CITY# ❑
cawsloN 03 - 1-- 2023 2006 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
PARK AVE N BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 10 00 FEET MILES e S B W e N 4 ST
1 2 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:7867205729 0 81
30
6 LAST NAME GOMEZ TELLEZ FIRSTNAME LUIS MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 1300 EAGLE RIDGE DR APT J-1066 CITY RENTON ST I WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 1❑ pl ATFBit BZP1376 sTAr� WA VIN# 4T1C11AK3NU696560
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 4 2022 TOYT CAMRY SD DAMAGE YES NO YES[:] No
No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO FARMERS 533972647 3 4
IN EFFECT &POLICY# STOP
EwcLe CHARGE 1 5 36
L YEs❑NO CITATION# 3A0292681 FLD SIGNAL STOPS/TURNS-UNSAFE
LEGALLY o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- A PROPERTY DAM THR OLD MET PHONE
16 a U PEDESTRIAN NIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2064369797
LAST NAME BRAUN FIRST NAME TED MIDDLE I J
INITIAL
17 STREET❑ NEW ADOREss❑' 446 WELLS AVE N APT 8 CITY RENTON ST WA ZIP 980575461 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[—] LDI IVEW # STATE WA SEX M MMDDW 12 _ 09 _ 1992 39
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET 5 INJURY 6 NATURE of INJURIES 40
USE CLASS LEG RUN OVER
❑21❑ PLATE# 4G2964 TArE 41
WA VIN# LC2U6G1099C001440 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2009 MAKE KYMC MODEL AGILITY STYLE MD DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 4701047-E26-47IN 1 STOP 5
VE."LE CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N�
❑ s
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED47092
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3420
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.
JASON TURNER 03-26-23 12:10 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 313112023 1:40:07 AM
BADGE OR ID# 12650 OR]#' WA0171300 TIME POLICE DISPATCHED 8:26 Pry TIME POLICE ARRIVED:8:33 PM
PART I PAGE IT]OF 4�
REPORT NO. ED47092 CASE# 23-3420 OF COLLISION
03/25/23 20:06
OF CbLLI510N
NARRATIVE
23-3420
On 03/25/2023 at approximately 2026 hours I was working as a Police Officer for the City of Renton.
While working I was dispatched to an injury accident at the intersection at Park Ave N and N 4th ST.
The notes of the call stated that it was a scooter vs. vehicle accident. The tire of the vehicle ran over
the scooter rider's leg. The rider was conscious and breathing.
Unit 1: 2022 Red Toyota Camry WA LIC: BZP1376
Driver: Luis M. Gomez-Tellez (DOB: 04/30/1989)
Unit 2: 2009 Red KYMC Agility WA LIC: 4G2964
Driver: Ted J. Braun (DOB: 12/09/1992)
The accident occurred as follows:
Unit 1 was taking a right out of the shell parking lot located at the 400 block of Park Ave N. He turned
onto Park Ave N going south bound in the number 2 lane approaching a red light at the intersection of
Park Ave N and N 4th ST. Unit 1 realized he needed to be in the #1 lane and went to change lanes
without checking his blind spot. Unit 2 was in the number 1 lane of Park Ave N and stopped his
vehicle at the above intersection next to Unit 1. Unit 2's scooter was struck by Unit 1's vehicle on the
left side of the scooter. This caused Unit 1 to fall off his scooter. Unit 2 stated his leg was run over by
Unit 1's vehicle, Unit 1 stated he wasn't certain if he ran over Unit 2's leg.
Unit 2 was treated on scene by fire, fire stated that he did not need to go the hospital. Unit 2 reported
minor pain to his leg, he was able to stand on it and walk. Unit 2 stated that he would be going to
urgent care on 03/26/2023 to get his leg checked out further. Unit 1 reported no injuries.
Unit 1's vehicle had minor cosmetic damage to the passenger side front bumper worth less than
$1000. Unit 2 had minor cosmetic damage to his scooter on the left and right rear side worth less
than $1000.
I created an exchange of information in SECTOR for both driver's and provided them a copy.
I cited Gomez-Tellez for Improper/Unsafe Lane Change (RCW: 46.61.305). This is because Gomez-
Tellez failed to look before changing lanes, causing the collision and injury of Braun.
There is no further information at this time.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by J. Turner 12650 on 03/26/2023 at 0007 hours.
PAGE 3 OF 4
REPORT NO. ED47092 CASE# 23-3420 DATE AND TIME 03/25/23 20:06
OF COLLISION
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