HomeMy WebLinkAbout23-8194 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED84864 170
27
COLLISION REP FIT 1591971
CASE 23-8194 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
GowsloN 07 - 1-- 2023 1904 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S SECOND ST BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259195962 0 11
30
6❑ LAST NAME RUCKER FIRSTNAME ANDREW MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 25832 113TH AVE SE APT 113 CITY KENT ST I WA 2jp, 98030 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 07 1- 05 - 1994 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aTES� CED3950 sTArI WAurN# KMHWF25S75A161912
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 1 2005 HYUN SONATA SD DAMAGE YES NO �LIkRS ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
❑ VE—LE CHARGE 106OTTOM 5 36
15 2 LEGA LN res No CITATION# 3A0381057,3A0381057 PROH/IMPROPER TURN,OP MOT VEH e
MOTOR PEDAL-:. 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2065952880
16 a
LAST NAME BOL FIRST NAME GOY MIDDLE I G
INITIAL
STREET
17 NEW ADOREs7 13445 MARTIN LUTHER KING JR W Q308 CITY SEATTLE ST WA Zip 98178 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVEW #
❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CFD8725 TArE 41
WA vIN# KM8SC13D33U527480 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2003 MAKE HYUN MODEL SANTA STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO GOYBOL 13445 MARTIN LUTHER KING JR WQ308 SEATTLE WA 98178 D:2065952880 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
— LE YES Nc❑ CITATION# 3A0381058,3A0381059 CHARGE NO VALID OPER LICENSE W/OUT ,o BOTTOM
LElA��Y
25 a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
GROZAV 1 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84864
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8194
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LOMBARDI JUSTICEA
(LAST FIRST,
ADDRESS&PHONE#
16156 126TH AVE SE RENTON WA 98058 2064193865 SEX i U MMDOYyry 09 - 08 - 1999
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 07-18-23 12:29 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:24:39 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED! 7:08 Pry] TIME POLICE ARRIVED]7:07 pry]
PART Ei PAGE IT]OF 4�
REPORT NO. ED84864 CASE# 23-8194 OF COLLISION
07/17/23 19:04
OF CbLLI510N
NARRATIVE
CASE 23-8194
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 Monday July 17th, 2023, at approximately 19:07, 1 responded to a 911 call regarding a two-
vehicle collision in the area of Safeway located at 200 S 3rd St within the City limits of Renton, King
County, Washington.
*** CALL REMARKS: 2 MVA... UNK INJ...ONE VEH APPEARS TO BE DISABLED... NON
BLOCKING.. GRY SEDAN VS. BRO SUV SUV...
-UNIT ONE: GRAY 2005 HYUNDAI SONATA WASHINGTON LICENSE: CED3950
-UNIT ONE DRIVER: ANDREW M. RUCKER (DOB: 07.05.1994)
-UNIT TWO: GOLD 2003 HYUNDAI SANTA FE SUV WASHINGTON LICENSE: CFD8725
-UNIT TWO DRIVER: BOL G. GOY (DOB: 3.30.2005)
1 arrived on scene and located the collision at the north entrance of Safeway off S Second St. Upon
arriving, I contacted the involved parties and confirmed there were no injuries. Goy reported he was
going straight in the left lane when unit one turned in front of him from the right lane. Goy was the
only occupant in the vehicle at the time of the collision. Goy's vehicle was towed from the scene due
to the damage.
Andrew said he was making a left turn into the Safeway parking lot when unit two struck him.
Although Andrew said he turned from the most left lane it was obvious he turned in front of unit two
from the damages to his vehicle. Andrew was the only occupant in the vehicle at the time of collision.
Andrew's vehicle was towed from the scene due to the damage.
A witness on scene, Justice A. Lombardi (DOB:9.08.1999) reported he was driving west on S Second
St and witnessed the collision. Justice reported unit one turned in front of unit two causing the
collision.
Andrew indicated he did not have insurance. Based on the circumstances I issued Andrew a traffic
infraction for the following violations (SECTOR CITE 3A0381057):
RCW 46.30.020- OP MOT VEH W/OUT INSURANCE
RCW 46.61.290- PROH/IMPROPER TURN
Goy also indicated he did not have insurance and he did not have a valid license. I ran a record check
on Goy and his driving status was listed as Not Licensed -Eligible. I issued Goy a traffic infraction for
the following violations (SECTORE CITE 3A0381058/1059):
RCW 46.30.020- OP MOT VEH W/OUT INSURANCE
RCW 46.20.005- NO VALID OPER LICENSE W/OUT IDENTIF (criminal citation sent to prosecutor
que)
All involved vehicles were provided a copy of the SECTOR exchange of information form and a copy
of their traffic infractions/citations.
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 7.17.2023 at 23:46 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED84864 CASE# ' 23-8194 DATE AND TIME 07/17/23 19:04
OF COLLISION
200 BLOCK S 2ND ST
SAFEWWAY NORTH ENTRANCE
1
PAGE 4 OF 4