HomeMy WebLinkAbout23-14072 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-14072 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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.. 12 - 1-- 2023 1645 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD STREET BLOCK NO. e✓ 1600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1437 FMILES EET e S ❑ W e OAKESDALE AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2533774677 0 7 30
6� LAST NAME CORTES FIRSTNAME MARTINEZ MIDDLE J 1 1 2 31
INITIAL
STREET ❑✓ 17644 118TH AVENUE SE CITY RENTON ST WA Zjp, 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 10 — 19 — 197-9 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9� P1 ATNES# LSP056 sTAT IA uN# 2V4RW3D15AR333513
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2010 VOLK ROUTAN VN DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO MARISOL TORRES LOPEZ311E 5TH ST MUSCATINE IA 52761 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO <53 4
LIABILITY INSURANCEIN EFFECT &POLICV# TOPvewcLE CHARGE OTTOM 5 36
LEGALLY YES❑NO CITATION# 3A0637886,3A0637886, INATTENTIVE DRIVING,NO VALID
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2532094651
VEHICLE CYCLE OWNER
16 a
LASTNAME CARTAGENA FIRSTNAME OTTO MIDDLE M
INITIAL
17 STREET I❑ 14526 200TH AVE E CITY BONNEY LAKE ST WA ZIP 983915492 37
NEW ADDREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—TRANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YEs I�/]NO❑
19 F] DRIVER'S STATE WA SEX M D.C.B. 12 _ 19 _ 1977 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# CGK9137 TATE 41
WA vIN# 5J8YE1HOOPL021892 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE ACUR MODEL MDX STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SHAYLA CARTAGENA 14526200TH AVE E BONNEY LAKE WA 983915492 D:2532094651 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSURANCE
#E CO USAA 030267553E 71013IN 1 STOP
VE""LE CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES Nu
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE32476
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14072
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CARTAGENA SHAYLA N
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
14526 200TH AVE E BONNEY LAKE WA 98391 2532094651 SEXi F MMDOYyry 02 - 10 - 1980
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 8 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 16 C/O NECK PAIN.TRANSP.VIA AMB.
VMC
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
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.
MATTHEW NUGENT 12-07-23 07:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 12/20/2023 10:03:57 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 4:49 Pry TIME POLICE ARRIVED 5:18 PM
PART I PAGE IT]OF 4�
REPORT NO. EE32476 CASE# 23-14072 OF COLLISION
12/07/23 16:45
OF CbLLI510N
NARRATIVE
23-14072
On 12/07/2023 at approximately 1701 hours, I was dispatched to vehicle collision with reports of
injury in the 1600 block of SW 43rd Street (aka S. 180th Street) within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised of a two-vehicle collision with one of the involved parties
complaining neck and back pain. Dispatch also advised that both vehicles were blocking the
roadway.
Upon arrival, the Renton Regional Fire Authority (RRFA) was on scene treating the involved parties.
The passenger of Unit#2 was later transported to Valley Medical Center (VMC) for further evaluation.
While on scene, Officer E. Sagiao and I collected the driving documents and independent recollection
from each of the involved parties leading up to the incident.
The driver of Unit#1 said he was the sole occupant of his vehicle and was traveling westbound in
about the 1600 block of SW 43rd ST in lane 1 of 2. The driver of Unit#1 stated he suddenly noticed
Unit#2 stopped directly in front of him in queued traffic. The driver of Unit#1 said that he was unable
to stop his vehicle in time subsequently colliding with the rear of Unit#2 causing significant damage
to the front of Unit#1.
The driver of Unit#2 said he and his adult passenger were also traveling westbound in about the
1600 block of SW 43rd ST in lane 1 of 2. The driver of Unit#2 stated he had come to a stop for
queued traffic ahead, and that while stopped, Unit#1 collided with the rear of Unit#2 causing
moderate damage to the rear of Unit#2.
Based on the above statements, I determined that the Driver of Unit#1 (Cortes) was the predominant
factor for the collision due to Inattentive Driving causing a collision.
I cited the driver of Unit#1 (Cortes) in-person for NVOL-with ID, Inattentive Driving, and operating a
motor vehicle without insurance.
Unit#1 had to be impounded due to extensive damage. Unit#2 was able to be driven away without
further incident. An exchange of information was provided to all involved parties.
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. Nugent#11498 7:42 PM 12/7/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE32476 CASE# ' 23-14072 DATE AND TIME 12/07/23 16:45
OF COLLISION
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