HomeMy WebLinkAbout24-2861 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SASE 24-2861 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK' FIRE HYDRANT
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 03 - 1-- 2024 0020 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e TAYLOR AVE NW
0 1 29
UNIT MOTOR
Z PEDAL-
CYCLE ❑ YESA,GEE NHORESHOLD MET PHONE 30
6� LAST NAME SCOTT FIRSTNAME VALERIE MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 7424 S 116TH ST CITY SEATTLE ST WA ZIP, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 I [NATURE OF INJURIES
H U EET 2 1 INJURY
CLASS ju POSSIBLE CONCUSSION z❑
3
10❑ P1 ATE 14 BMA0853 STATE WA VIN# 4A4MN21S74E051575
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN#j VIN#
FROM
34
13❑ VEH.YEAR2004 MAKE SITS MODEL ENDEAV STYLE VEHICLE TOWED NOOpLSABLIN TSIYYEp9vMEYERS YEs❑ENo /
DAMAGE IILLJJII (��IV6
REGISTERED OWNER INFO FE1711SC0TT 1424 S 116TH ST SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LEGALLY STANDING
MOTUNIT VE IOOR PEDAL- PROPE❑ CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY [:]I
DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIRIVERSTICENS # STATE SEX MMDDYY -❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. '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
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE59677
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2861
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) V►RGILIO QUITON QUILLOPO
(LAST FIRST,
ADDRESS&PHONE#
1863 MAKUAH/NE ST HONOLULU H!96817 8082565677 SEX M MMDOYyry 12 - 11 - 1971
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
[:]WITNESS✓❑' POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYVYV
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.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.
JAKE GALL 03-16-24 01:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 311612024 2:20:13 PM
BADGE OR ID# ! 12617 ORI#' WA0171300 TIME POLICE DISPATCHED 12:22 AM TIME POLICE ARRIVED 12:24 AM
PART I PAGE IT]OF 4�
REPORT NO. EE59677 CASE# 24-2861 OF COLLISION
03/16/24 00:20
OF CbLLI510N
NARRATIVE
*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. Statements have been paraphrased and
summarized. *
The following occurred within the City of Renton, WA and was recorded on my body worn camera.
On 03/16/2024 at around 0022 hours, Renton Officers were dispatched to a single vehicle collision
located near the intersection of Renton Ave Ext and Taylor Ave NW. The call notes stated that the
vehicle was turned over on its side. Renton Fire was started as precaution for injuries.
Once on scene, I observed vehicle 1 was already upright on the North sidewalk, facing Northbound. It
appeared the vehicle 1 was driving Westbound up Renton Ave Ext when an unknown distraction led
driver 1 to jump the curb and impact a fire hydrant.
I attempted to contacted driver 1 (and sole occupant of the vehicle) who was still in the driver's seat.
She was not very responsive and was unable to recall what happened. I noticed a small cut on her
finger but did not observe any other obvious injuries. Renton Fire began evaluating Driver 1.
I spoke with witness Quiton Quillopo Virgilo who was still on scene. He stated that he was driving his
vehicle Westbound on Renton Ave Ext nearing the Taylor Ave NW intersection. He observed vehicle
1 traveling Westbound on Renton Ave Ext in the far-right lane. Just after the Taylor Ave NW
intersection, Vehicle 1 appeared to have hopped on the curb and clipped the fire hydrant on the North
sidewalk with its front passenger quarter panel. This impact caused vehicle 1 to rotate North and tip
onto its driver's side. The vehicle did not roll as there was no damage to the roof of the vehicle.
Quiton and other passersby stopped and pushed the car upright onto all four wheels.
Driver 1 appeared to be confused about what was happening and was likely concussed. Medic One
arrived on scene and began to backboard Driver 1 for potential head or spine injuries due to the
mechanism of impact. Driver one was transported to Harborview for further treatment and evaluation.
I did not locate any insurance cards inside the vehicle.
I photographed the scene, which was later uploaded to evidence.com
Gene Meyers arrived on scene and took possession of the vehicle.
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 J. Gall/12617
03/16/24 at 0150 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. EE59677 CASE# 24-2861 DATE AND TIME 03/16/24 00:20
OF COLLISION
I
y
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PAGE 4 OF 4