HomeMy WebLinkAbout23-4053 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4053 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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# ❑
COLLISION.. 04 — 11 — 2023 0620 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. e✓ 2000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FMILES EET e S ❑ W e BLA/NEAVENE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2068412930 0 11
30
6� LAST NAME MALDONADO-ADAME FIRSTNAME JOSE MIDDLE R 1 2 31
INITIAL
STREET ❑ 21616 30TH AVE S APT 1 CITY DES MOINES ST WA 2jp, 98198 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U EETI I INJURY [NATURE OF INJURIES
CLASS ju PAIN/DISCOMFORT TO CHEST z❑
3
10 9❑ P1ATE14 D79067B sTAr WAvN# 1FTYR14V5YPA67264
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 7 34
13 4 2000 FORD RANGE PK DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO VERN FONK 2007080181 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3AO344352 IMPROPER LANE USAGE BOTTOM
15❑ MOTOR STANDING 7 6
-:. PROPERTY THR OLD MET PHONE
UN�T 0' ❑✓ PEDAL ❑ PEDESTRIAN ❑ ❑ DAM 1/ NO D:9072425871
VEHICLE CYCLE OWNER
YES
16 a
LAST NAME RISKE FIRST NAME TREVOUR MIDDLE J
INITIAL
17 STREET I❑ s❑' 566 ALPINE RIDGE PL NW CITY ISSAQUAH ST WA ZIP 98027 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYEs❑No� INTERLOCK ves No� YEs NOF
19 LDICENIVERS STATE WA SEX M MMDDYY O6 _ 02 _ 1991 39
WELMET INJURY6 NATURE OF INJURIES 40
20� ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 USE CLASS STOMACH PAIN
❑21❑ PLATE# BKR1509 TAre WA VIN1t 5XXGT4L33HG165800 41
1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2017 MAKE /(//� MODEL OPTIMA $D DAMAGE TO ✓WED NO GENE MEYERS YES NOO BLIN TOWED II OV 44
H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04341131078IN 9TOP
'E""Le ❑ ,J� CITATION# CHARGE BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
BRETT WILLET 12257 WA0171300
PART A PAGE 01 OF
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52152
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4053
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.
BRETT WILLET 04-11-23 02:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 411712023 5:44:05 PM
BADGE OR ID# 12257 ORI#' WA0171300 TIME POLICE DISPATCHED! 6:25 AM TIME POLICE ARRIVED]6:29 AM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED52152 CASE# 23-4053 OF COLLISION04/11/23 06:20
NARRATIVE
Portions of this incident were captured on my Body-Worn Camera. Please See that for complete
detail of witness statements and incident details.
On 04.11.2023, 1 was working for the Renton Police Department as 1-Robert-22, fully uniformed and
in a marked patrol vehicle. At approximately 0625 hours, I was dispatched to the 2000 block of NE
3rd St, in the City of Renton, County of King, and the State of Washington to investigate a collision.
VEHICLES INVOLVED:
Unit# 01: 2000 Ford Ranger, WA LIC# B7906713; Driven by: Jose R. Maldanado-Adame (DOB:
02.17.77)
Unit# 02: 2017 Kia Optima, WA LIC# BKR1509; Driven by: Trevour J. Riske (DOB: 06.02.91)
INCIDENT:
I arrived on the scene and observed that Unit# 01 was in the left lane of westbound traffic facing east
and Unit# 02 was in the right lane of westbound traffic facing west, partially on the sidewalk. The
damage to both vehicles was consistent with a head-on collision.
I spoke to the driver of Unit# 02 and asked him what happened. He told me he was westbound on
NE 3rd St in the left lane when Unit# 01 crossed the center line and collided with him head-on.
Trevour stated that he was wearing his seatbelt and that his stomach hurt.
I then spoke to the driver of Unit# 01, using a Spanish interpreter. He told me that he was eastbound
on NE 3rd St in the left lane when his truck began to fishtail. This action caused him to cross the
center line and he collided with Unit# 02. Jose stated he was wearing his seatbelt and complained of
chest pain.
Renton Fire Authority arrived on the scene and evaluated both drivers. Both declined to be
transported to a medical facility.
Both vehicles were towed from the scene privately by Gene Meyer's towing.
I provided both drivers with an information exchange sheet and a business card with the case number
and my information on it.
I told Jose that he would be receiving a citation in the mail for Improper Lane Usage, RCW 46.61.140.
1 declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
ELECTRONICALLY SIGNED
Officer B. Willet# 12257
Renton, WA/ County of King
State Of Washington
04.11.2023
1412 hours
PAGE 3 OF 4
REPORT NO. ED52152 CASE# 23-4053 DATE AND TIME 04/11/23 06:20
OF COLLISION
CASE-42 405',a
NOT TSSCALE
U
'o
L
co
W
PAGE 4 OF 4