HomeMy WebLinkAbout23-6631 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6631 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK' TREE OR STUMP
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 06 - 11 - 2023 0112 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
200 S 2ND STREET BLOCK ST e✓
MILEPOST 200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069155602 30
6� LAST NAME JIMENEZOROZCO FIRSTNAME UZIEL MIDDLE 1 2 31
INITIAL
STREET ❑ 24415 64TH AVE S SPC 2 CITY KENT ST WA ZIP 98032 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYES NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑
USE CLASS j I POSSIBLE BROKEN LEFT ARM
3
10❑ Pl QTNFS# BVZ2552 STATE WA VIN#' 2B4GP44342R743871
TRAILER STATE TRAILER STATE
11 1 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN#j VIN#
FROM
34
13 1 VEH.YEAR2002 MAKE DODG MODEL CARAVA STYLE VN VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYER v�s❑ENo�
❑ DAMAGE IILLJJII (SciV6
REGISTEREDOWNERINFO SALOMONGONZALEZSOTO22542108THAVESE KENT WA98031 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE❑ NSURANCE CO NIA 4
IN EFFECT M:
POLICY# <gg
VE—LE CHARGE36
LEGALLv YES❑NO CITATION#
15❑ G�UNIT a2 VEHICMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YES I t I.OF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN1 41
1
PLATE#
42
22 R TILER❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I vEwGLE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N J
s � e
7MICAELA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 CASTAIN 7 12573 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73307
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6631
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
POS. 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'
On 06-11-2023 at approximately 0112 hours I was dispatched to a collision that occurred at the 200
block of S 2nd Street, in the City of Renton, King County, WA.
Upon arrival, I contacted Uziel Jimenez (DOB 08/02/2001), who was the driver of a Dodge Grand
Caravan (WA/BVZ2552). Jimenez advised the registered owner, Salomon Gonzalez (DOB
10/17/1990), is his uncle.
Jimenez advised that he was traveling westbound in lane 1 at the 200 block of S 2nd Street. Jimenez
advised the front window was fogging up which impaired his vision, so he tried to turn the windshield
wipers on. While he was activating the windshield wipers he looked down, and realized he was
veering off the road. Jimenez advised by the time he tried to correct the steering wheel; he was
already colliding into a tree on the south side of S 2nd street.
Jimenez was complaining of pain to his left arm. Jimenez's left arm appeared to be fractured or
possibly broken. Renton Fire arrived on scene to provide medical treatment for Jimenez. Jimenez
was transported to Valley Medical Center by Trimed.
The Grand Caravan was towed to Gene Meyer Towing Lot. There is damage to the front bumper,
front tires, and the air bags were deployed.
Jimenez does not have insurance for the vehicle. I provided Jimenez with the case number and my
business card.
This concludes my involvement with this case.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Castain #12573 6/11/2023 Renton, King County, WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAELA CASTAIN 06-11-23 03:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 6/24/2023 1:10:30 PM
BADGE OR ID# 12573 OR]# WA0171300 TIME POLICE DISPATCHED! 1:12 AM TIME POLICE ARRIVED';1:19 AM
PART I PAGE IT]OF
REPORT NO. ED73307 CASE# 23-6631 DATE AND TIME 06/11/23 01:12
OF COLLISION
200 block of S 2nd Street N
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