HomeMy WebLinkAbout23-6069 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-6069 2 676
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4Y00 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 N E IN CITY# ❑
cawsloN 05 - 1-- 2023 1306 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BRONSON WAY NE BLOCK NO. e✓ 275
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 323 00 FMILES EET e S B W e NE 3RD STREET
2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:3607069301 2 3 30
6 LAST NAME PINZON GOMEZ FIRST NAME ANTONIO MIDDLE 0 7 31
INITIAL
STREET ❑, 16715 NE 100TH ST CITY REDMOND ST WA 7jp, 980523150 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ pl ATFBit AEJ8224 sTAr� WA urN# 3N1CB51D15L593368
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. $ 1 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 2 200$ NISS SENTRA 4D DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO ANGELICA MEND.2702 NE 4TH CT RENTON WA 98056 D:3607069301 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 10BOTTOM 5 36
LEGALLY YES❑NO CITATION# 3A0431054,3A0431054 IMPROPER LANE USAGE,OP MOT
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ )WNPR ❑ YES 1/ NO D:7022660475
16 a
LAST NAME CAJIAO DELGADO FIRST NAME JOSE MIDDLE D
INITIAL
17❑ NEW STREETR 7 1221 SW 139TH ST APT 299 CITY' BURIEN ST WA ZIP 981661136 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK ves No� YEs NOF
19 F] DRIVER'S STATE WA SEX M D.O.B. 10 �_ 27 1992 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLA E# CDC8743 TArE 41
WA VIN1 3VWC576UXKM254805 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE YOLK MODEL,/ETTA STYLE QD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO JOSE CAJIAO DELGADO 1221 SW 139TH STAPT 299 BURIEN WA 98166 D:7022660475 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO STATE FARM 536 5736-DOB-47IN 9TOP
'E"'LE ❑ ,J� CITATION# CHARGE BOTTOM
LEGALLY YES N`LJ 6
25 =UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED65637
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6069
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
PM 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'
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 05-30-23 01:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 513112023 12:40:05 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 1:15 PM TIME POLICE ARRIVED',1:21 PM
PART I PAGE IT]OF 4�
REPORT NO. ED65637 CASE# 23-6069 OF COLLISION
05/29/23 13:06
OF CbLLI510N
NARRATIVE
23-6069
On 05/29/2023 at approximately 1315 hours, I was dispatched to a blocking vehicle collision at 275
Bronson Way NE, within the City Limits of Renton, County of King, State of Washington.
While en route, Dispatch advised that there was a two-vehicle collision, and that both vehicles were
blocking the roadway in front of the Kaiser Permanente location.
Upon arrival, I noticed both involved vehicles had airbag deployment and significant damage suffered
therefore I requested the Renton Regional Fire Authority (RRFA) respond as a precaution. RRFA
later responded but both involved parties declined treatment and stated they were okay.
The driver and sole occupant of Unit#1 was positively identified by pictured WADL. The driving of
Unit#1 stated he was traveling northbound on Bronson Way NE. The driver of Unit#1 stated he was
negotiating the curve, specifically in the 200 block of Bronson Way NE, where he was met by Unit#2
in what can be described as an offset head-on collision. Upon reviewing the vehicle position, it was
evident that Unit#1 had crossed the center lane as most of Unit#1 occupied the southbound lane of
travel even though the vehicle was facing northbound and the driver revealed he had been traveling
northbound. The driver of Unit#1 claimed that he was not distracted but believed there to be a
mechanical failure with the vehicle's steering mechanism which caused Unit#1 to leave its lane of
travel and collide with Unit#2.
The driver and sole occupant of Unit#2 was identified via pictured WADL and stated he was traveling
southbound in the 200 block of Bronson Way NE approaching NE 3rd ST. The driver of Unit#2 stated
that while continuing south, he observed Unit#1 come into his lane of travel. The driver of Unit#2
stated he was unable to avoid the collision in time, and subsequently collided with Unit#1 causing
significant damage to the front of Unit#2, specifically the front drivers side wheel, fender, and
bumper.
Based on the above statements, I determined that the Driver of Unit#1 (Pinzon Gomez) was the
predominant factor for the cause of collision as Pinzon Gomez violated RCW 46.61.140 -Driving on
Roadways Laned for Traffic. This RCW states that any vehicle shall be driven as nearly as
practicable entirely within a single lane and shall not be moved from such lane until the driver has first
ascertained that such movement can be made with safety. Pinzon Gomez drove into the oncoming
lane of travel, whether by distraction or mechanical failure. Pinzon Gomez also did not have proof of
motor vehicle insurance and was therefore cited for both violations (Lane Travel and No Insurance) in
-person.
Both Units had to be towed from the scene due to extensive damage. 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 5/30/2023 1:02 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED65637 CASE# ' 23-6069 DATE AND TIME 05/29/23 13:06
OF COLLISION
7s
� � ' o��ay
N
Kaiser Permanente
PAGE 4 OF 4