HomeMy WebLinkAbout23-4279 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4279 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF; M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 1-- 2023 1659 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON AVE S
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S ❑ W e S 132 ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2063679589 0 11
30
6❑ LAST NAME ARNOLD FIRSTNAME DEBORAH MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 24116 62ND WAY S APT 16-102 CITY KENT ST WA 2jp, 98032 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 10 1- 31 - 1965 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� BKZ0303 sTAr� WAVIN# 1G1BC5SM8J7223675
C.... TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE FROM TO
rRLR. TRLR.. 7 3 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 3 34
13 4 2018 CHEV CRUZE SD DAMAGE vEs No �LWkRS YES NO✓
[WIREGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILITY INSURANCE INSURANCE CO GENERAL ASSURANCE CORP 53-WA-9780498 4
IN EFFECTPOLICY# TOPvEBI LE CHARGE 36
LECALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:42526065
16 72
a
LAST NAME GRIGLIO FIRST NAME LORI MIDDLE lK
INITIAL
17 NEW STREETR 14620 S
7 E 140TH PL CITY RENTON ST WA ZIP 98059 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK vEs It I NOF YES
t l NOF,/
19 D IVEW #
❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AJF9450 TArE 41
WA VINE 1C46JWDG4CL283344 1
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
GI
VEH YEAR 2012 MAKE JEEP MODEL WRANGL STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED By ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 807850430IN 1 9TOP
VE."LE ❑ ,J� CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N J
$ '
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52135
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4279
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 04-16-23 10:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 411712023 5:43:13 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 5:01 PM TIME POLICE ARRIVED',5:05 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED52135 CASE# 23-4279 OF COLLISION
04/16/23 16:59
OF CbLLI510N
NARRATIVE
CASE 23-4279
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 Sunday April 16th, 2023, at approximately 17:01, 1 responded to a 911 call regarding a two-
vehicle collision near the intersection of Renton Ave S and S 132nd St in the City of Renton, King
County, Washington.
***CALL REMARKS: AT 132ND/RENTON AVE S...2 MVA...SIL SEDAN AND SIL JEEP....AIRBAG
DEPLOYED, LINK INJS. SIL JEEP VS SIL SEDAN, ***NOW DECLINING AID - CANCEL FD.
-UNIT ONE: SILVER 2018 CHEVROLET CRUZE WASHINGTON LICENSE: BKZ0303
-UNIT ONE DRIVER: DEBORAH D. ARNOLD (DOB: 10.31.1965)
-UNIT TWO: GREY 2012 JEEP WRANGLER UNLIMITED WASHINGTON LICENSE: AJF9450
-UNIT TWO DRIVER: LORI K. GRIGLIO (DOB: 2.05.1960)
1 arrived on scene and contacted Deborah who said she rear ended unit 2. Deborah did not report any
injuries and was the sole occupant in the vehicle. Unit 1 had to be towed from scene due to sever
front end damage. Gene Meyers arrived and towed the vehicle.
I contacted Lori who said she was stopping for a pedestrian in the cross walk when she was rear
ended by Deborah. Lori did not report any injuries and she was the sole occupant in the vehicle at the
time of the collision. Lor was able to drive her vehicle away from the scene since there was only
minor damage to her vehicle.
Both Deborah and Lori had valid driver's licenses and valid vehicle insurance.
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 19:15 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED52135 CASE# ' 23-4279 DATE AND TIME 04/16/23 16:59
OF COLLISION
N
NOT TO SCALE
RENTON AVE S
},r
f
rtf
S 132ND ST
PAGE 4 OF 4