HomeMy WebLinkAbout23-4244 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4244 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
cowsloN 04 - 1-- 2023 1624 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e AIRPORT WAY
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4026139364 0 11
30
6❑ LAST NAME LIU FIRSTNAME ALLEN MIDDLE H 1 2 31
INITIAL
STREET ❑ 608 CEDAR AVE S CITY RENTON ST WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 08 1- 20 - 1954 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10[1 PICENSE1I ATE 14 BPY7381 STATE WA uN# 1G1AK55F977104389
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 5 7 33
12 0 0 VIN#' VIN#'
:: FROM TO
VEH.YEAR 2007 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 CHEV COBALT SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 932021960 3 4
IN EFFECT &POLICY# Q�,Q,
VE"C CHARGE 36
LECALLv Yes❑NO❑ CITATION#15❑ NDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2067349932
16 1
LAST NAME ORTEGA FIRST NAME ROGELIO MIDDLE
INITIAL
17 STREET NEW ADDREs7 9061 SEWARD PARK AVE S APT 9-160 CITY SEATTLE ST' WA ZIP 98118 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19� DRIVER'S STATE WA SEX M D.O.B. 03 05 _ 1990 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLATE# BVJ5206 TATE WA VIN# 19VDE1F58EE014439 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE ACUR MODEL ILX STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO BRITTANY BRACE 22815240TH AVE SE MAPLE VALLEY WA 98038 D:2534096273 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04335-76-21-69IN I 5VE—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. ED52129
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4244
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BRACE BR/TTANYN
(/AST FIRST,
ADDRESS&PHONE#
22815 240TH AVE SE MAPLE VALLEY WA 98038 2534096273 SEXi F MMDOYyry 08 - 30 - 1994
PASSENGER WITNESS UNIT# ! 2 POS 3 AIRBAG 2 RESTR, 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
USE 2 CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# BEd MMDDYYYY DOB
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 04-16-23 12:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 411712023 5:43:22 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 4:25 Pry] TIME POLICE ARRIVED]5:26 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED52129 CASE# 23-4244 OF COLLISION
04/15/23 16:24
OF CbLLI510N
NARRATIVE
CASE 23-4244
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 April 15th, 2023, at approximately 16:26, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of Rainier Ave N and Renton Ave extension in the City of Renton,
King County, Washington.
'CALL REMARKS: 2 MVA, UNK INJ, BLOCKING INTERSECTION.
-UNIT ONE: BLACK 2007 CHEVROLET COBALT WASHINGTON LICENSE BPY7381
-UNIT ONE DRIVER: ALLEN H. LIU (DOB: 08.20.1954)
-UNIT TWO: WHITE 2014 ACURA ILX WASHINGTON LICENSE BVJ5206
-UNIT TWO DRIVER: ROGELIO ORTEGA (DOB: 3.05.1990)
1 arrived on scene and contacted Allen who reported he was taking a left turn onto Renton Ave Ext
from Rainier Ave S when he was hit by unit 2 who was traveling south on Rainier Ave N. Allen
believed he had the green light since he was moving with traffic. Allen was the sole occupant in the
vehicle and did not report any injuries. Unit 1 was drivable, and Allen was able to drive away from the
scene.
I contacted Rogelio who reported he was traveling south on Rainer Ave N when unit 1 turned in front
of him. Rogelio indicated he had the green light to go through the intersection. Rogelio and his
passenger Brittany N. Brace (DOB:8.20.1994) were not injured. Unit 2 needed to be towed from the
scene since it was not drivable. Gene Meyers Towing later arrived and towed the vehicle.
There were no independent witnesses on scene to verify who had the green light.
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 04.16.2023 at 00:08 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED52129 CASE# ' 23-4244 DATE AND TIME 04/15/23 16:24
OF COLLISION
RANINER AVE N
NOT TO SCALE
ENTON AVE EXT__
PAGE 4 OF 4