HomeMy WebLinkAbout23-4221 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4221 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.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 04 - 14 - 2023 2043 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RANTER AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e RENTON AVE EXT
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2065516447 0 4 30
6❑ LASTNAME ESQUIBEL-ROBINSON FIRSTNAME VIANA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 7322 RAINIER AVE S UNIT 302 CITY SEATTLE ST I WA 2jp, 98118 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ I INTERLOCK YES NO�/ YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1— 04 — 1990 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CFG7480 sTArI WAurN# 2C3CDXBGOLH187832
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /[g GOVT.VEHICLE 34
13 2020 DODG CHARG SD DAMAG 5 7 E YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO DAMES HENDERSON 6229 S 238TH STAPTL202 KENT WA 98032 D:2069483655 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO STATE FARM 529 9172-F12.47A 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:9096340716
16 a
LAST NAME CHEN FIRST NAME JEFFREY MIDDLE IC
INITIAL
17 STREET NEW ADOREs7 210 NW 5TH ST CITY RENTON ST WA ZIP 98057 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] DRIVER'S STATE WA SEX M D.C.B. 07 11 1994 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# HECK TArE WA VIN# JF1 GR7E68CG200460 41
1
42
22❑ PILER LATE# STATE PLATE# STATE
T
23❑ 43
IN# IN RLR
#.UIN#. '
TOWED BY Gov HI 44
VEH YEAR 2012 MAKE S(JB�Q MODEL ►MPREZA STYLE HB DAMAGE TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSU&PORGY#E CO STATEFARM 485 2573 A28 47IN 1 5
VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � e
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. ED52150
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4221
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HENDERSON JAMES E
(LAST FIRST,
ADDRESS&PHONE#
6229 S 238TH ST APTL202 KENT WA 98032 2069483655 SEX M MMDovyvv 03 - 04 - 1981
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) HSU CHESTER E
ADDRESS&PHONE# D O E4
210 NW 5TH ST RENTON WA 98057 9099717547 SEX u MMDDYYvv 05 _ 04 _ 1991
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 04-15-23 02:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 411712023 5:43:39 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED; 8:46 PM TIME POLICE ARRIVED',8:47 PM
PART Ei PAGE IT]OF 4]
REPORT NO. ED52150 CASE# 23-4221 OF COLLISION
04/14/23 20:43
OF CbLLI510N
NARRATIVE
CASE 23-4221
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 Friday April 14th, 2023, at approximately 20:46, 1 responded to a 911 call regarding a two-vehicle
collision at the intersection of Rainier Ave S and Renton Ave extension in the City of Renton, King
County, Washington.
'CALL REMARKS: 2 MVA... NI... BLOCKING MIDDLE OF INTERSECTION.... HAZ LIGHTS....
RP'S VEH POSS NEEDS TO TOW.... NEW RP REPORTING SAME, RP UNABLE TO MOVE VEH
OUT OF RDWAY, HAZARDS ON.. DISC FOR PD ONSC.
-UNIT ONE: WHITE 2020 DODGE CHARGER WASHINGTON LICENSE CFG7480
-UNIT ONE DRIVER: VIANA D. ESQUIBEL-ROBINSON (DOB: 07.04.1990)
-UNIT TWO: BLACK 2012 SUBARU WASHINGTON LICENSE HECK
-UNIT TWO DRIVER: JEFFREY C. CHEN (DOB: 7.11.1994)
1 arrived on scene and contacted Viana who reported she was taking a right turn on to Renton Ave
Ext from Rainier Ave N when Jeffrey ran the red light and hit him the in the intersection. Viana was
not injured and did not appear to be injured. Viana's front passenger/registered owner James E.
Henderson (DOB: 3.04.1981) was sitting in the front passenger seat at the time of the collision. He
also did not report any injuries. Viana was able to driver unit 2 away from the scene.
I contacted Jeffrey who reported he was as taking a left turn onto Renton Ave Ext from Rainier Ave S
when he was hit by unit 1. Jeffrey cleared the intersection when the collision occurred. Jeffrey
indicated he had a green light when he entered the intersection. Jeffrey and his passenger Chester E.
Hsu (DOB: 5.04.1991) were not injured. Unit 2 was towed away from the 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 04.15.2023 at 02:17 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED52150 CASE# 23-4221 DATE AND TIME 04/14/23 20:43
OF COLLISION
w U'%
NOT TO SCALE ow
R`ENTON AVE EXT
RANIER AVE
PAGE 4 OF 4