HomeMy WebLinkAbout23-6122 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-6122 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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 0941 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NORTH SOUTHPORT DR BLOCK NO. e✓ 1100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a GARDEN AVE NORTH
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2064886996 N:2064886996 o 11 30
6 LAST NAME RIVERA PEREZ FIRST NAME BYRON MIDDLE S 1 2 31
INITIAL
STREET ❑ 33422 192ND AVE SE UNIT 91 CITY AUBURN ST WA 2jp, 980922269 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 3 RESTR 4 EJECT 1 H U EET 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE B4 BMA0356 JBTATIJ WA V N If 1ZVBP8AM8D5237457
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 2 2013 FORD MUSTAN CP DAMAGE vE6 0NO f �AWkkRS vEs❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 915687823 3 4
IN EFFECT &POLICY# 9TOP
vEGALLY HICLE 5 36
YES No CITATION# 3A0431057 CHARGE FAIL TO OBEY TRAFFIC CONTROL o sorrow
15❑ LE STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
✓ PEDESTRIAN
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ ''. OWNER
❑ YES 1/ No D:8087565738 N:8087565738
16 a
LAST NAME TOMASU FIRST NAME AUSTIN MIDDLE I K
INITIAL
17❑ NEW STREETRE— 10732 20TH PL E CITY' EVERETT ST WA ZIP 98209 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK v�Esl I I NOF YES
t l NO�
19� DRIVERS
# STATE WA SEX M Mr D.C.B. 04 10 _ 1989 39
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLA E# CCY4759 TArE 41
WA VIN# 1FMCUOEZ2NUA84780 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE FORD MODEL ESCAPE STYLE SI/ VEHICLETOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO✓
REGISTERED OWNER INFO SIEMENS INDUSTRY INC 666 GARLAND PL DES PLAINES IL 60016 D:8087565738 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO TRAVELERS PROPERTY CAS.CO.OF AMERICA TC2JCAP744OL34ATIL21 STOP
IN EFFECT
- 5
VEwCLE LEG ❑ N,J� CITATION# CHARGE BOTTOM
ALLY YES 6
25 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. ED67201
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6122
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST 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'
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 05-31-23 05:15 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 6/5/2023 2:28:36 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 9:42 AM TIME POLICE ARRIVED',9:42 AM
PART I PAGE IT]OF 4�
REPORT NO. ED67201 CASE# 23-6122 OF COLLISION
05/30/23 09:41
OF CbLLI510N
NARRATIVE
23-6122
On 05/30/2023 at approximately 0943 hours, I was dispatched to a blocking vehicle collision at the
intersection of Garden Avenue North and North Southport Drive, within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised that two vehicles were involved in a collision and blocking the
intersection. Officer J. Singer arrived on scene and determined there were no injuries requiring
immediate medical response at the time of report.
Upon my arrival, 1 collected each involved party's information and their independent recollection of
their involvement leading up to the collision.
The driver of Unit#1 stated he was the sole occupant of his vehicle and was traveling northbound on
Garden Ave N approaching the intersection of N Southport Dr in lane 2 of 2. The driver of Unit#1
stated he was intending to continue north through the intersection. The driver of Unit#1 stated that he
drove into the intersection on what he claims was a yellow traffic signal displayed for his direction of
travel. The driver of Unit#1 stated that upon entering the intersection, he collided with Unit#2
causing significant damage to the front of Unit#1, specifically the front bumper and quarter panel on
the passenger side.
The driver of Unit#2 said he was the sole occupant of his company vehicle and was traveling
westbound on N Southport Dr approaching the intersection of Garden Ave N (a.k.a. Lake WA Blvd N)
in lane 3 of 5. The driver of Unit#2 stated he was intending to continue west through the intersection.
The driver of Unit#2 stated that prior to reaching the intersection of Garden Ave N, he noticed the
traffic signal for his direction of travel had been green for several seconds. The driver of Unit#2
continued through the intersection on what was described as a stale green light when he was struck
by Unit#1 causing significant damage to the front driver's side, specifically the front bumper, fender,
and wheel on the driver's side.
Based on the above statements, 1 determined that the Driver of Unit#1 (Rivera Perez) was the
predominant factor for the cause of collision due to Failing to Obey a Traffic Control Legend. While on
scene, the traffic legend controlled intersection was functioning properly and therefore I believe that
Unit#2 had a green light for several seconds which would indicate that Unit#1's direction of travel
would have a red light. The driver of Unit#1 was not paying attention to the posted traffic light at the
intersection causing a collision. 1 therefore cited Rivera Perez via mail for Failing to Obey a Traffic
Control Legend.
Both Unit#1 and Unit#2 had extensive damage and had to be impounded. 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 5/31/2023 5:06 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED67201 CASE# 23-6122 DATE AND TIME 05/30/23 09:41
OF COLLISION
Unit
�� '6 ar�ram nat do scale:
Vm
#1
N Southport
Unt M2
\� 9
Z
Q
0
PAGE 4 OF 4