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HomeMy WebLinkAbout24-6622 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-6522 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS . 02 STRUCK RESERVATION z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION' 08 - 22 - 2024 2005 17 ❑.❑ S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK JEFFERSON AVE NE ST e✓ MILEPOST 400 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 20 00 FEET MILES e S B W e INDEXAVENE �I 0 1 29 "�� � VEHICR Z LE CYCCLE. ❑ �ESAGE NHORE✓LD MET PHONE 30 6 LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY RENTON Sr ZIP z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8 DRIVER'S. STATE : SEX.U D.Q.B. 1 32 ❑ :LICENSE# MMDDYY —= 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAEY 0 NATURE OF INJURIES z❑ 3 10 9❑ PI ATE 14 "BE"OR"JE" JBTATIJ vN# TRAILER TRAILER STATE STATE 11 2 5 PLATE# PLATE# ROM TO TRLR. TRLR 1 5 33 12❑ VIN# UIN# FROM TO VEH.YEAR MAKE KIA MODEL UNKNO STYLE P4 VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 4 DAMAGE YES NO YES❑ NO✓ REGISTEREDOWNERINFO UNKNOWNUNKNOWN UNKNOWN RENTON WA VEHICLE NO. 1 SHADEIN DAMAGED AREA ❑ 35 4 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 ❑ UNKNOWN UNKNOWN IN EFFECT &POLICY# 9TOP VEHICLE RGE 5 36 LEGALLv Yes❑NO❑ CITATION# CHA 10 BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2085107089 16 a LAST NAME BOLIVAR MEXAS FIRST NAME ANDRES MIDDLE A INITIAL 17 STREET❑ NEW ADOREss❑' 270 BRONSON WAY N CITY RENTON ST WA ZIP 98059 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED 38 INTERLOCK YES�NOR INTERLOCK YEs It I NO YES t l NO❑ 19 DRIVE # STATE SEX M M D.O.B. 07 1 21 39 --] F—NATURE OF INJURE 20 ON DUTY STATUS 1 AIRBAG RESTR EJECT 3 H BEET 8 CLASSY 8 LACERATION TO ARMS/LEGS.HEAD CONTUSION ❑ 40 ❑21❑ TATE 41 IN#LICENSE V 4 PLATE# 42 22 [TRAILER T ❑ PLATE# STATE PLATE#ILER STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO IGQVE""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 4 4 D.NELSON 12421 WA0171300 OFFICER'S PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE91672 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6622 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) POOLER KIMBERYD (LAST FIRST, ADDRESS&PHONE# 1203 N 2ND ST RENTON WA 98057 4256524798 SEXi F MMDOYyry 03 - 27 - 1999 PASSENGER WITNESS IT# SEAT AIR BAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES �,UN POS. USE :CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEXI MMDDYYYV PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&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. D.NELSON 06-22-24 09:11 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE G.BARFIELD 6476 1 71112024 8:24:07 AM BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED! 8:08 PM TIME POLICE ARRIVED',8:08 Pm PART B PAGE IT]OF 4� REPORT NO. EE91672 CASE# 24-6622 FC LNaoy L isI©�ON O 06/22/24 20:05 F cu NARRATIVE 24-6622 I NJ H R On 6/22/2024 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the City of Renton. I was dispatched to a report of a hit and run collision with injury near the intersection of NE 3rd St and Jefferson Ave NE Renton/King/WA. A witness, later identified as Kimberly D Pooler DOB: 3/27/1999, called to report that a bicyclist had been struck by a purple Kia that had fled the scene west on NE 4th St. I arrived on scene and located the victim on Jefferson Ave NE about twenty feet south of Index Ave NE. The victim was identified as Andres A Bolivar Mejias DOB: 7/21/1990 by a WADL photograph. Andres has a laceration to his right leg just below the knee, bruising and road rash to his upper right arm, and a contusion to the right side of his head. RRFA arrived on scene and evaluated Andres, he declined all medical assistance and asked for a friend to pick him up. RRFA personnel recommended that he go to the hospital since he told them he lost consciousness, but he refused. I spoke with Kimberly who said that they were driving south on Jefferson Ave when they saw a white SUV open its passenger door striking Andres as he rode his bicycle south on Jefferson. She said that this did not knock Andres off the bike, and he kept riding, but the white SUV was followed by a purple Kia that struck Andres on the passenger side front bumper. She said that Andres rolled off the car and hit the ground. The Kia and white SUV fled the scene south on Jefferson and then west on NE 4th. Kimberly said the purple Kia had a license plate that started with either"BE" or"JE". She had no further description of the white SUV. Andres's bicycle has a bent back tire/wheel. I took photographs of Andres and his bicycle and uploaded them to Axon Evidence. I spoke with a neighbor who lived nearby, and they checked their surveillance and advised they did not have the suspect vehicles, or the collision captured. Nothing further. PAGE 3 OF 4 REPORT NO. EE91672 CASE# 24-6622 DATE AND TIME 06/22/24 20:05 OF COLLISION as Nam' m u 4 PAGE 4 OF 4