HomeMy WebLinkAbout23-7296 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-7296 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 06 - 1-- 2023 1052 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NORTH 3RD ST BLOCK NO. e✓ 1500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e FACTORYAVE NORTH
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:4257668699 0 11
30
g� LAST NAME STEWART FIRSTNAME TERON MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 24216 197TH PL SE CITY MAPLE VALLEY ST I WA 2jp, 980388763 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� 53025D sTATI WAvIN# 1 FT7X2667BEC96132
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 3 33
12 2 5 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 1 2011 FORD F2PU 4C DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CITY RENTON 3555 NE 2ND ST RENTON WA 98056 D:4257668699 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO CITY OF RENTON SELF INSURED 1 3 4
IN EFFECT &POLICY#
VEHICLe 9TOP
CHARGE 5 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068524596
16 a
LAST NAME CORREA GARCIA FIRST NAME MARGARITA MIDDLE
INITIAL
17 STREET I❑ s❑' 12502 63RD AVE E CITY' PUYALLUP ST WA ZIP 983738815 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK v�Esl I I NOF YEs t l NO�
19� D IVEW # STATE WA SEX F M D.O.B. 08 _ 14 1990 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
CLS
21❑ LICENSE I PLA E# CBJ4880 TATE WA VIN# WMWZF3C59CT267765 1
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2012 MAKE MNNI MODEL COOPER STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO MARGARITA CORREA GARCIA 1300 EAGLE RIDGE DR S APT 110 RENTON WA 98055 D:2068524596 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 887-882-195IN 1 9TOP 5
vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s a
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76154
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7296
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
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 06-27-23 03:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOSS 1953 7/3/2023 3:22:28 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED, 10:54 AM TIME POLICE ARRIVED',11:06 AM
PART I PAGE IT]OF 4�
REPORT NO. ED76154 CASE# 23-7296 OF COLLISION
06/27/23 10:52
OF CbLLI510N
NARRATIVE
23-7296
On 06/27/2023 at approximately 1054 hours, I was dispatched to a non-injury and blocking vehicle
collision at the intersection of North 3rd Street and Factory Avenue North, within the City Limits of
Renton, County of King, State of Washington.
Upon my arrival, 1 confirmed there were no complaints of injury at the time of report. There, I collected
the involved parties driving documents and their independent summary of the collision.
The driver of Unit#1 stated that he was the sole occupant of his City of Renton work vehicle and was
traveling eastbound on N 3rd ST approaching the intersection of Factory Ave N in lane 1 of 3 (one-
way street). The driver of Unit#1 stated that he was intending to continue straight (east) through the
intersection. The driver of Unit#1 stated that upon entering the intersection, he observed Unit#2
approach the same intersection but from the south. Unit#1 stated that both vehicles collided in the
intersection and that Unit#1 suffered minor damage to a metal cone rack that was previously affixed
to the front of Unit#1 but was severed off as a result of the collision. The driver of Unit#1 did not
immediately recall the color of the traffic light for his direction of travel but believed it was green.
The driver of Unit#2 stated that she was the sole occupant of her vehicle and was traveling
northbound on Factory Ave N approaching the intersection of N 3rd ST. The driver of Unit#2 stated
that she had a stale green light for her direction of travel and that the light did not change to yellow
until she was already in the intersection. The driver of Unit#2 stated that she noticed Unit#1
approach the intersection from the West and that both vehicles collided in the intersection. Unit#2
suffered moderate damage to the driver's side doors/rear fender of her vehicle.
No witnesses were immediately available at the scene.
Based on the above statements, 1 was not able to determine the predominant factor for the collision.
Both drivers claim that the other involved party failed to yield to the other party. I told both of the
involved parties to contact their respective insurance companies for filing.
Both Unit#1 and Unit#2 were able to be driven away without further incident. 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 6/27/2023 3:07 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED76154 CASE# 23-7296 DATE AND TIME 06/27/23 10:52
OF COLLISION
`Diagram not to scale
Unit#1
North 3rd Street
Un it#2
0
z
0
t
CID
LL
PAGE 4 OF 4