HomeMy WebLinkAbout23-5849 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5849 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENC 4100 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# ❑
cowsloN 05 - 1-- 2023 1142 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FEET MILES e S B W e S 15TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254959159 0 81
30
6� LAST NAME VARGAS FIRSTNAME FRANKLIN MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 10833 SE 172ND ST APT 7D CITy RENTON ST WA 2jp, 980555943 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aTES� BYH0343 sTAr� WAurN# KMHEC4A40CA028641
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 4 2012 HYUN SONATA 4D DAMAGE vesNo � �MEYERS YES❑ No
REGISTERED OWNER INFO ALEXANDRA VARGAS 1.33 SE 172ND STAPT D7 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14LIABILI INSURANCE INSURANCE CO ALL STATE817550989 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3AO463528 INATTENTIVE DRIVING 1 o Sorrow
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ DD 2067862333
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME JENKINS FIRST NAME DABRIEL MIDDLE N
INITIAL
17❑ STREET Is❑' 6537 30TH AVE SW CITY SEATTLE ST WA ZIP 981264218 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t%✓ NO❑
19 LICENSE#DRIVER'S STATE WA SEX MMDC7YY
F D.O.B. 09 _ O6 _ 1989 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS BACKANDNECK
❑21❑ PLATE# CFV9745 TArE 41
WA VIN1i 3CZRU6H71GM746507 1
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2016 MAKE HOND MODEL HR-I/ STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JON JENKINS 675037TH AVE SW SEATTLEWA98126 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 9684671888IN 1 9TOP
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES Nu
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED78985
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5849
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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 5-24-23 at about 1156 1 arrived in the 1400 block of Talbot Rd S for a 2-vehicle injury collision.
Both vehicles were still in the roadway and occupied by the drivers. Driver 1 was being tended to by
Renton Fire Authority (RFA) for possible injuries. Driver 1 was just still sitting in his vehicle.
Driver 1 told me;
He was northbound when the light turned red. By the time he realized it was red, he was unable to
stop and collided with unit 2.
He was uninjured.
Driver 2 was still in her vehicle being triaged by RFA. Driver 2 told me;
She was stopped at the red light when she was struck by unit 1.
She was in pain.
Both drivers were identified via WADL. Unit 1 was towed due to disabling damage by Gene Meyers
towing. Unit 2 was moved to a nearby parking lot by RFA members.
Driver 2 was transported to Valley Medical Center by ambulance for back and neck pain.
I cited driver 1, Vargas via complaint for inattention.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 06-05-23 01:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 711212023 4:15:22 PM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 11:54 AM TIME POLICE ARRIVED 11:56 AM
PART I PAGE IT]OF
REPORT NO. ED78985 CASE# ' 23-5849 DATE AND TIME 05/24/23 11:42
OF COLLISION
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