HomeMy WebLinkAbout23-8398 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8398 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 5 1 2$
TRIBAL 1 OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 07 - 1-- 2023 1541 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EDMONDS AVE NE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 12TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2067351518 0 11
30
6❑ LAST NAME WILSON-MEJORADO FIRSTNAME GABRIELLE MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 1823 HARRINGTON AVE NE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 12 1- 21 - 1996 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 2❑ I Pi ATNES# CGW6027 sTAr WAuN# 1N46t4BV8LC236694
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2020 NISS ALTIMA SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TLI I� RS GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No � YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE INSURANCE CO GEICO 4612-71.80.41 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4252238520
16 a
LAST NAME OSGOOD FIRST NAME RACHEL MIDDLE JA
INITIAL
17 NEW STREETREs7' 18727 SE 44TH PL CITY ISSAQUAH ST WA ZIP 98027 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVEW # STATE WA ]SEX IF M D.O.B. O6 _ 04 1994 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLA E# A/Y6430 TArE WA VIN# 2G4 WC582061250867 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
TOWED BY Gov HI 44
VEH YEAR 2006 MAKE BUIC MODEL LACROS STYLE $D —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4695267 E1547IN 1 VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � e
7BRYAN
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. ED84857
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8398
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MAZE MAR/AM J
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1823HARRINGTONAVENE RENTON 98056 SEXi F MMDOYyry 12 - 20 - 1986
PASSENGER Z WITNESS❑'UNIT# 1 POS 9 AIRBAG j 2 RESTR. 4 EJECT ? 1 HELMET NJURY NATURE OF INJURIES
USE 1 2 'CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
BEd 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 07-23-23 02:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:25:29 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 3:44 PM TIME POLICE ARRIVED',3:47 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED84857 CASE# 23-8398 OF COLLISION
07/22/23 15:41
OF CbLLI510N
NARRATIVE
CASE 23-8398
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 Saturday July 22nd, 2023, at approximately 15:44, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of Edmonds Ave Ne and NE 12th St within the City limits of
Renton, King County, Washington.
-UNIT ONE: Gray 2020 NISSAN ALTIMA WASHINGTON LICENSE: CGW6027
-UNIT ONE DRIVER: GABRIELLE M. WILSON-MEJORADO (DOB: 12.21.1996)
-UNIT TWO: SILVER 2006 BUICK LACROSSSE WASHINGTON LICENSE: AIY6430
-UNIT TWO DRIVER: RACHEL A. OSGOOD (DOB: 6.04.1994)
1 arrived and contacted the involved parties and confirmed there were no injuries. Both parties
declined aid. Gabrielle said she was heading west on Ne 12th St and proceeded through the
intersection after stopping at the stop sign. While in the intersection she involved in a collision.
Gabrielle did not know how the crash occurred and believed she had the right of way to proceed
through the intersection. Rachel had a rear passenger Mariam J. Maze (DOB:12.20.1986) at the time
of the collision who also was not injured.
Rachel reported she was traveling north on Edmonds Ave Ne and proceeded through the intersection
after stopping at the stop sign. While in the intersection she was involved in collision. Rachel also did
not know how the crash and believed she had the right of way to proceed through the intersection.
Since both drivers reported the same thing that they did not know how the collision occurred and
there were no independent witnesses on scene, it was unknown how the collision occurred. Both
vehicles were towed from the scene due to the damages.
All involved vehicles were provided a copy of the SECTOR exchange of information form.
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 7.23.2023 at 02:13 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED84857 CASE# ' 23-8398 DATE AND TIME 07/22/23 15:41
OF COLLISION
N
NOT TO SCALE
NE 12TH ST
EDMONDS AVE N-E
PAGE 4 OF 4