HomeMy WebLinkAbout23-544 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 23-544 z
INTERSTATE CITY STREET FIRE
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
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 01 - 1-- 2023 1311 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFHOUSER WAYN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2532297728 0 11
30
6❑ LAST NAME WANQUIST FIRSTNAME DYLAN MIDDLE I M 1 1 2 31
INITIAL
STREET ❑ 34729 26TH PL SW CITY FEDERAL WAY ST I WA 2jp, 980233086 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 04 1- 09 - 1994 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10[1P1 ATE 14 AWJ7947 STATE WA v N# JH4KA96654C004862
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR. 5 1 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2004 ACUR 3.5RL DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO MICHAEL,WA1QUIS13472926TH PL SW FEDERAL WAY WA 98023 D:2532297728 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALL STATES17208693 3
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062801322
16 a
LAST NAME MENDEZ FIRST NAME YURIDIA MIDDLE
INITIAL
17❑ STREET ❑', 2418 FERNDALE PL NE CITY' RENTON ST WA ZIP 980568368 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NoF YES t l NO❑
19 LICENSE# STATE WA ]SEX IF M .C... 04 11 1988 El 39
H USE ET NJAURSY [NATURE.1 INJURIES COMPLAINT OF SHOULDER PAIN ❑ 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 6
21❑ LICENSE BGD0983 TATe I WA vIN# JN8AF5MV66T024699
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE NISS MODEL JUKE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO YURIDIA MENDEZ 2418 FERNDALE PL NE RENTON WA 98056 D:2062801322 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 4394259-C14-47AIN STOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
D.LAMOTHE 11677 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED26356
COLLISION REPORT III III III III III 111
1591972 CASE# 1 23-544
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MENDEZ TANIA F
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2418 FERNDALE PL NE RENTON WA 98058 SEXi F MMDDvyvv 03 - 25 - 2006
UNIT# ! 2 POST 1 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
PASSENGER Z WITNESS[]
USE 2 CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL) MENDEZ-REBOLLAR WILLIAM
ADDRESS&PHONE# D Q B
2418 FERNDALE PL NE RENTON WA 98058 SEX M MMDDvyvv O6 _ O6 _ 2011
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
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.
D.LAMOTHE 01-14-23 02:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 111912023 8:15:41 AM
BADGE OR ID# 11677 ORI# WA0171300 TIME POLICE DISPATCHED 1:17 Pry] TIME POLICE ARRIVED:1:29 Pry/
PART I PAGE IT]OF 4�
REPORT NO. ED26356 CASE# 23-544 OF COLLISION
01/13/23 13:11
OF CbLLI510N
NARRATIVE
On the above listed date and time I was dispatched to the intersection of Bronson Way N and Houser
Way N, in the City of Renton, County of King, State of Washington, reference a two vehicle collision.
Upon arrival, I located the involved vehicles and spoke to the involved parties.
Vehicle #1 was parked on the side of the roadway on Factory Ave N. I observed minor damage to the
rear bumper of the vehicle. Vehicle #2 was parked in the Bigfoot Java parking lot on the northwest
side of the intersection. I observed moderate damage to the front end of of Vehicle #1 with the plastic
covering around the front bumper and quarter panels hanging off of the vehicle.
Driver#1 stated that he had been traveling northbound on Houser Way N to head straight across the
intersection to travel north on Factory Ave N. He stated that he was behind a large truck, which
blocked his view of the traffic light. The truck ahead of him went through the intersection and he
followed. While traveling through the intersection his vehicle was impacted by Vehicle #2, which was
traveling westboung on Bronson Way N. Driver#1 stated he was unaware of what color the traffic
light was.
I spoke to Driver#2 who stated she was traveling westbound in the #2 lane (closest to the center
lane) on Bronson Way N and stated that she had a green light. At this time, Vehicle #1 went through
the intersection heading northbound, directly in front of her vehicle, causing her to impact with Vehicle
#1.
Driver#2 complainted of some shoulder pain but declined medical aid. The two passengers in
Vehicle #2 were uninjured.
Driver#1 was issued a verbal warning for failing to stop for a red light.
PAGE 3 OF 4
REPORT NO. ED26356 CASE# ' 23-544 DATE AND TIME 01/13/23 13:11
OF COLLISION
Factory Ave N.
Bronson Way,fV,
w.a
Houser Way S.
PAGE 4 OF 4