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Home My WebLink About23-7042 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c COLLISION REP FIT 1591971 CASE 23-7042 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 04 STRUCK' TREE OR STUMP RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN ✓ CITY# ❑ cawsloN 06 - 1-- 2023 0722 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ LIND AVE SW BLOCK NO. e✓ 3401 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 250 00 FEET MILES e S B W e SW 34TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:9178479424 1 4 30 6� LAST NAME BASS FIRSTNAME DIANE MIDDLE 1 1 2 31 INITIAL STREET ❑, 801 RAINIER AVE N F231 CITY RENTON ST I WA 2jp, 98057 z NEW ADDRESS 7❑ CDL ✓ I IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs No NTERLOCKYEs NO✓ YES R No 8❑ LRIIVER # I INJURY [NATURE OF INJURIES 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 H U EET CLASS ju SCRAPE TO HAND z❑ 3 10❑ PI ATE 14 BCG6754 sTAr WAv N# 1J4Gt58K75W574036 IT STATE TRAILER STATE 11 3 5 PLATE# PLATE# Rom ro TRLR. A'RLR. 1 5 33 12 0 0 VIN#j VIN# FROM 34 13� VEH.YEARN MAKE JEEP MODEL LIBERT STYLE UT VEHICLETOWED0NOOffBLIN TSIgWgYMEYERTOWINC� VEHICLE DAMAGE IILLJJII (5�IV6 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 4 14 LIABILITY INSURANCE TRAVELERS INSURANCE 6006975652031 IN EFFECT &INSURANCE CO POLICY# VEwcLE CHARGE ❑ 36 LEGALLv res❑NO❑ CITATION# BOTTOM 15❑ STANDING 6 UNIT VE IOOMOTR PEDAL- PROPE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLDMET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY SEATTLE ST ZIP 4 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/ 19 LLIICENS # STATE SEX U MMDDYY —�_ ❑ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG g RESTR 9 EJECT '1 USE 9 CLASS 0 ❑ ❑21❑ PLATE# C19418D TAre WA VIN1i 5TEVL52NX3Z189053 41 1 42 22❑ PIR ILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2003 MAKE TOYT MODEL TACOMA STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV!TN 44 24❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO CARLOS ARAGON 512 S DONOVAN ST SEATTLE WA 98108 D:2067391706 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIAIN BILITY INSURANCE❑ &POINSULICY#E CO UNKNOWN STOP 5 VEHICLE YES[:] ,.I—I CITATION# CHARGE io BOTTOM LEGALLYN 25 0( OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 STEVEN FAJARILLO 12847 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED72618 COLLISION REPORT III III III III III 111 1591972 CASE# 23-7042 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) UNKNOWN SHAUNA (LAST FIRST, ADDRESS&PHONE# RENTON 4252414155 SEX i U MMDOYyry - - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) '. NESS KARLA ADDRESS&PHONE# DOB 28410 239TH PL SE MAPLE VALLEY WA 98038 2068180187 SEX: F MMDbvuvv 01 _ 05 _ 1973 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. 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. STEVEN FAJARlLLO 06-21-23 04:29 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 1 6/22/2023 11:09:08 AM BADGE OR ID# ( 12847 OR]# WA0171300 TIME POLICE DISPATCHED 7:24 AM TIME POLICE ARRIVED',7:Y9 AM FART I PAGE IT]OF 5� TIME REPORT NO. ED72618 CASE# 23-7042 OF COLLISION06/21/23 07:22 NARRATIVE 23-7042 On 06-21-2023 1 was working as a police officer in the city of Renton. At approximately 0724 hours I was dispatched to the report of an injury collision at La Tortilla Mexicana, 3401 Lind Ave SW, City of Renton, County of King, WA. This incident was captured on my department issued Axon body camera and my vehicle's Axon camera system. According to the notes in the call, in front of the location on Lind Ave SW there was a hit and run collision with people trapped inside of a vehicle. One female was able to get out of the vehicle and was conscious and breathing. Later, it was reported not a hit and run, but a single vehicle swerved off the road and hit unoccupied cars in a parking lot. I arrived on scene and contacted the driver of Vehicle 1, Diane Bass (DOB: 08-29-1955). 1 confirmed her identity by Department of Licensing photograph. She was outside of the vehicle and was the lone occupant of Vehicle 1. She stated she had no injuries other than some abrasions on her hand. Renton Fire Authority arrived and recommended she go to the hospital to be evaluated, but she refused. Diane told me she was driving south on Lind Ave SW past the intersection at SW 34th St. A black SUV was driving east on SW 34TH St and turned south onto Lind Ave SW as she was passing through the intersection. Diane said she swerved to avoid a collision with the black SUV. She never collided with the black SUV, and the SUV continued south on Lind Ave SW. Diane tried to correct her steering, but lost control and swerved onto the west shoulder of Lind Ave SW. She continued through the grass, belonging to La Tortilla Mexicana, and collided with Vehicle 2 and Vehicle 3 parked in the parking lot. I provided Diane with a case number. There was nothing of evidentiary value seen inside Vehicle 1. Vehicle 2 and Vehicle 3 were unoccupied in the parking lot. Vehicle 2 had significant damage to the engine and front of the vehicle. Vehicle 3 had significant damage to the rear bumper and had a broken rear window. The owners of Vehicle 2 and Vehicle 3 were employees of La Tortilla Mexicana. The grass had gouges and tire marks in it. I watched surveillance footage of the incident provided by James, who was the supervisor of La Tortilla Mexicana. It showed Vehicle 1 travelling south on Lind Ave SW in the inside lane. As Vehicle 1 passed through the intersection, a black SUV turned south onto Lind Ave SW from SW 34th St. It appeared the black SUV turned into the outside lane, but I was unable to confirm if it travelled into the inside lane first. Vehicle 1 is seen swerving to the left initially and then back and forth until both vehicles go out of view from the camera. The collision is not seen on the surveillance footage. Officer Ignatov provided the supervisor with a Community Request link to upload the surveillance footage to Evidence.com. A witness, Karla Ness, explained a similar story to the surveillance video and Diane. Karla did not have any further information on the collision or the black SUV. Looking at the scene it appeared Vehicle 1 collided with a tree prior to hitting Vehicle 1 and 2. There was no damage to the tree. The supervisor of La Tortilla Mexicana contacted the owners of Vehicle 2 and Vehicle 3 to inform them of the incident and provided them with a case number. I photographed the scene, damage to the vehicles, and uploaded the pictures to Evidence.com. Gene Meyers Towing arrived to impound Vehicle 1 and Diane signed the tow form. After investigation, there was no crime. Based on the information gathered I was unable to determine which driver caused the collision. There is no further information available at this time. 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 S. Fajarillo #12847 on 06/20/2023 @ 1430 hours in Renton WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED7261 8 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-7042 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES� IN 1 4 29 LAST NAME : UNKNOWN FIRST NAME MIDDLE INITIAL STREET 30 NEW AnnRFS CITY KENT ST ZIP 6 1 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES NO zERLOCK YES❑N0� vES N DRIVER'S STATE I SEX U M��DYSYv' -� 2 LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ 1 32 LICENSE I CCR1930 [TAT WA VIN# JFlZNBE11N9755754 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 O O VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1C P FROM TO 2022 TOYT GR86 CP DAMAGE YES NO YES NO REGISTERED OWNER INFOMAURIGO CALLES-SEGOVIA 27537 140TH AVE SE KENT WA 98042 D:2067872114 m 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE[] INSURANCE CO IN EFFECT &POLICY# t 9 1"01? EHICLE o BOrroM 34 13 LEGALLY YES NO CITATION# CHARGE STANDING ❑ 4❑ MOT{7R PEDAL PROPERTY a 7 e 14 ❑ UNIT# 1:1DAMAGE THRESHOLD MET PHONE ❑ 35 VEHICLE CYCLE PEDESTRIAN OWNER YES NO ✓ D:2534416182 N:2067631488 36 15 ❑ LAST NAME LA MEXICANA FIRST NAME TOR TILLA MIDDLE INITIAL 16 ❑ STREET"[] 3401 LIND AVE SW CITY RENTON STI WA ZIP 98057 NEW AnnRFSR CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED 17 ❑ INTERLOCK YES NO INTERLOCK YEs NO YEs NO ❑ DRIVER'S STATE SEX U D.O.B 5 37 18 ❑ LICENSE# MMDDYYY — ON DUTY STATUS AIRBAG RESTR, EJECT HELMET INJURY NATURE OF INJURIES ❑ 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ [441 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LecALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. STEVEN FAJARILLO 06-21-23 04:29 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OBADGE R ID# 12847 O#I',WA0171300 APPROVED BY 612212023 PAGE F OF 5 3000-345-013(R 11118) REPORT NO. ED72618 CASE# 23-7042 DATE AND TIME 06/21/23 07:22 OF COLLISION SW34 HST .. LEGEND. VEHICLE2 ,-: POINT OFIMPACT ' . NOT TO SCALE: VEHICLE 3 U1 Z J PAGE 5 OF 5