HomeMy WebLinkAbout23-6228 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6228 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 06 - 01 - 2023 1616 17 ❑.❑ S 8 W H OF e 1070 3
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 100
4a 1❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255241198 0 11
30
6❑ LAST NAME IGWE FIRSTNAME UCHANMA MIDDLE H 1 2 31
INITIAL
STREET ❑, 10549 SE 228TH ST CITY KENT ST WA 2jp, 98031 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1— 19 — 1976 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� UCHANMA sTArI WAVIN# JTEBU46FXEK200011
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 1 5 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5
014 34
13 4 2 TOYT FJ UT DAMAGE YES NO YES[:] ✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 914338837 4
LI EFFECT &SUR N# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
NO ,/ D:3606896078
16 a
LAST NAME COOK FIRST NAME CAMERON MIDDLE E
INITIAL
17❑ STREET NEW ADDREs�' 801 VENETA AVE APT 3 CITY BREMERTON ST WA ZIP 98337 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] DRIVER # STATE WA SEX M M D.C.B. 08 _ 24 1999 39
—NATURE OF INJURIES
H USE CLASS
NJAURSY COMPLAINT OF BACK PAIN 40
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7
❑21❑ 41
ILICENSE PLA E# B98778L TAre WA VIN# 1FTPW14V28F675559 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE FORD MODEL F150 STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO INC WATERS AND WOOD 3040 B STNWSTE 8 AUBURN WA 98001 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE❑ INSURANCE CO MUTUAL OF ENUMCLAW CPP 002268103
IN EFFECT &POLICY# I 9TOP
°LF Yes Nc❑ CITATION# 3A0381048 CHARGE OP MOT VEH W/OUT INSURANCE o BOTTOM
GALLY
25 $ '
7BRYARN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED68636
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6228
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TR/NH RIAN S
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
9601 STEILACOOM BLVD SW LAKEWOOD WA 98498 SEX M MMDDYyry 01 - 16 - 1996
PASSENGER I�I WITNESS❑',UNIT# 1 POST ', y AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE of INJURIES
L`!1 USE 2 CLASS +1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
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.
BRYAN GROZAV 06-02-23 12:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 6/9/2023 2:44:11 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 4:29 PSI TIME POLICE ARRIVED',4:Y8 Pm
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED68636 CASE# 23-6228 OF COLLISION06/01/23 16:16
NARRATIVE
CASE 23-6228
SECTOR CITE: 3AO381048
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Thursday June 1st, 2023, at approximately 16:21, 1 responded to a 911 call regarding a two-
vehicle collision at near Brown Bear carwash located at 77 Rainier Ave S within the City limits of
Renton, King County, Washington.
*** CALL REMARKS: *CONTACT IFO LOC ON SIDE OF RAINIER* 2 MVA, NI, NB, MORE THAN
$1000 DAMAGE, REQ OFCR ASSIST. RP IS INVD, REQ AID 23 YOM FOR BACK--PT IN WHI
FORD F150.
-UNIT ONE: GREEN 2014 TOYOTA FJ-CRUISER WASHINGTON LICENSE: UCHANMA
-UNIT ONE DRIVER: UCHANMA H. IGWE(DOB: 07.19.1976)
-UNIT TWO: WHITE 2008 FORD F150 WASHINGTON LICENSE: B98778L
-UNIT TWO DRIVER: CAMERON E. COOK (DOB: 8.24.1999)
1 arrived on scene and contacted the involved parties and confirmed there were no injuries. Cameron
complained of back pain and was examined by the Renton Fire Dept. on scene and released on
scene. Cameron said he was rear ended while stopped in traffic. Cameron was the sole occupant in
the vehicle at the time of the crash.
I contacted Uchanma who said Cameron began to drive forward and abruptly stopped. Uchanma and
her passenger Rian S. Trinh (DOB:1.16.1996) did not report any injuries.
Both unit one and two had minor damage and were able to drive from the scene.
All involved vehicles were provided a copy of the SECTOR exchange of information form.
Cameron did not have valid insurance, so I issued him an infraction for RCW 46.30.020- OP MOT
VEH W/OUT INSURANCE. I provided Cameron the infraction at the scene.
This concludes my involvement in this case.
I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.
Electronically signed by B. Grozav #12489 on 6.01.2023 at 23:59 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED68636 CASE# ' 23-6228 DATE AND TIME 06/01/23 16:16
OF COLLISION
i
i
NOT TO SCALE
100 BLOCK RAINIER AVE S
3
PAGE 4 OF 4