HomeMy WebLinkAbout23-5632 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-5632 2 6 0
INTERSTATE CITY STREET 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
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cawsloN 05 - 18 - 2023 2330 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 43RD ST BLOCK NO. e✓ p
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e OAKESDALE AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066797059 0 4 30
6� LAST NAME MATAMOROS FIRSTNAME ALLAN MIDDLE U 1 1 2 31
INITIAL
STREET ❑, 11029 SE 223RD PL APT B CITY KENT ST WA 7jp, 98031 2
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 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� CFX5186 sTArr~ WAvIN# 1HGCM563X6A111885
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 4 HOND ACCOR SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ARTURO FLO.DOMINGUEZ 19100116THAVE SE RENTON WA 98058 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# C�TOP
VEHlcl.e CHARGE 1 5 ❑ 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252240335
16 a
LAST NAME NGUYEN FIRST NAME CAO MIDDLE T
INITIAL
17 STREET❑ NEW ADDREss❑' 465 NILE AVE NE CITY RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 11 08 _ 1966 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CHD1912 TArE 41
WA VIN1 2T3DWRFV3KW001987 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE TOYT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HOAI NGUYEN 465 NILE AVE NE RENTON WA 98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY 410644001557 5
IN EFFECT
--E ❑ ,J� CITATION# CHARGE
25 C�Q
LEGALLY YES N`L J
s � a
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. ED61932
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5632
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CONTRERAS RAFAEL C
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
22608 17TH PL WEST BOTHELL WA 98021 2069282497 SEX M MMDOYyry 10 - 24 - 1985
PASSENGER WITNESS❑',UNIT# POS. 3 AIRBAG,2 RESTR. 4 EJECT ? 1 HEL EET 2 CLASs 1 NATURE OF INJURIES
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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.
MICAELA CASTAIN 05-19-23 01:05 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 512012023 11:31:59 AM
BADGE OR ID# 12573 OR]# WA0171300 TIME POLICE DISPATCHED! 11:30 PM TIME POLICE ARRIVED',11:30 PM
PART Ei PAGE IT]OF 4]
REPORT NO. ED61932 CASE# 23-5632 OF COLLISION
05/18/23 23:30
OF CbLLI510N
NARRATIVE
Unit 1: Honda Accord (WA/CFX5186); Allan Matamoros (DOB 12/13/2003)
Unit 2: Toyota Rav4 (WA/CHD1912); Cao Nguyen (DOB 11/08/1966)
On 05-18-2023 at approximately 2330 hours I located two vehicles that appeared to have been in a
collision at SW 43rd Street and Oakesdale Ave SW, in the City of Renton, King County, WA.
There appeared to be no injures upon contacting both parties. Nguyen was the only occupant of Unit
2. Matamoros was the driver of Unit 1, along with passenger, Rafael Contreras (DOB 10/24/1985).
1 spoke to Matamoros, who advised that he was traveling eastbound on SW 43rd Street, through the
intersection and had a green light. Matamoros advised that Nguyen ran his red light but was unaware
which direction Nguyen was traveling from.
I spoke Nguyen who said that he was making a left hand turn onto SW 43rd Street to travel
eastbound from Oakesdale with a green light. Nguyen advised Matamoros collided with him as he
was making the left-hand turn.
I spoke to a witness, Steven Romano (DOB 01/23/1994), who advised he was traveling behind
Matamoros. Matamoros traveled eastbound through the red light and collided with Nguyen. Romano
showed me dash camera video from his phone. I asked Romano if he would send the video, however
he was unable to correctly share the video.
There is damage to Unit 1's driver side doors. There is damage to Unit 2's passenger side front
bumper. Both vehicles appeared to be drivable.
Based on the statements made, there is proximate cause for Matamoros (Unit 1) for the collision.
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 5/19/2023 Renton, King County, WA
PAGE 3 OF 4
REPORT NO. ED61932 CASE# 23-5632 DATE AND TIME 05/18/23 23:30
OF COLLISION
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PAGE 4 OF 4