HomeMy WebLinkAbout23-8784 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8784 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F E: LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK NONE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
C{YLLISION O8 - O1 - 2023 1906 17 ❑.= S 8 W IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 5700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e NILE
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:5245246975 1 9 30
6[ LAST NAME CHAVEZ FIRSTNAME ISMAEL MIDDLE E 1 F 2 31
INITIAL
STREET ❑ 14300 SE 171 ST WAY,APT 16 CITY RENTON ST WA 2jp, 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR I [NATURE OF INJURIES
4 EJECT 1 H USEET 2 1 INJURY CLASS ju CUT ON HEAD ABOVE EYEBROW z❑
3
10 1❑ LICENS P1 ATE 14 D09525D sTAr WAV N# 4TARN81A7RZ193668
0 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 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[AWk GOVT.VEHICLE 34
13 4 1994 TOYT VST CW DAMAG 5 7 E YES NO YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv YEs❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068568099
16 a
LAST NAME DING FIRST NAME ZHAO MIDDLE H
INITIAL
17 STREET NEW ADOREs7 5221 NE 3RD PL CITY RENTON ST WA ZIP 98059 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 10 _ 01 1987 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 5 RESTR 4 EJECT 1 H U EET 2 NJAU EY O NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BVK9510 TArE 41
WA VIN# SFNRL6H74LB010085 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BV Gov HI 44
VEH YEAR 2020 MAKE HOND MODEL ODYSSEY STYLE VN —TEHICLE
TOWED✓ NOO BLIN GENE MEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY
INSURANCE &POLICY#E CO SAFECO H2404516IN 1 9TOP
VEHICLE YES[:] N
C[:] CITATION# CHARGE i o BOTTOM
LEGALLY
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
WHITNEY NELSON 12789 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88766
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8784
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROSEL LOPEZ DANIEL
(LAST FIRST,
ADDRESS&PHONE#
14300 SE 171ST WAYAPT16 RENTON WA 98058 SEX M MMDOYyvv 02 - 02 - 2004
SEAT HELfv1ET INJURY NATURE OF INJURIEs
PASSENGER WITNESS❑',UNIT# 1 POS. 3 AIRBAG 9 RESTR. 4 EJECT 1 USE CLASS 16 BROKEN ARM
NAME
(LAST,FIRST,MIDDLE INITIAL) ROSEL CHAVEZ CHRISTIAN
ADDRESS&PHONE# D O 8
14300 SE 171ST WAY APT 16 RENTON WA 98058 SEX I M MMDDYvvv 11 _ 10 _ 2003
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 5 AIRBAG 9 RESTR. 2 EJECT 1 USE CLASS 7 H!P/LEG
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.
WHITNEY NELSON 08-01-23 11:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 8/13/2023 12:45:30 PM
BADGE OR ID# 1Y789 OR]# WA0171300 TIME POLICE DISPATCHED! 7:08 PM TIME POLICE ARRIVED',7:13 PM
PART Ei PAGE IT]OF 4]
TIME
REPORT NO. ED88766 CASE# 23-8784 OF COLLISION08/01/23 19:06
NARRATIVE
23-8784
On at 1906 hours I was dispatched to Nile AVE NE/NE 4TH ST, in the City of Renton, King County,
Washington. I was responding to a blocking accident.
While en route, dispatch advised there were two vehicles involved with unknown injuries and Fire had
been started to assist.
Unit#1 was facing Westbound on NE 4TH and was sitting in the middle turn lane in front of Nile AVE
NE facing West. Unit#1 had front end damage, fluids leaking from the vehicle and the passenger
door had a dent in the side panel, it appeared totaled.
Upon arrival I made contact with Unit#1 to see who was injured and get any identification from them.
Unit#1 was occupied times 3, driver, middle passenger and far right passenger. Driver had a cut by
his eyebrow that was bleeding, and the far-right passenger was holding his right arm in pain. The
middle passenger did appear to have some kind of knee or hip pain, he was limping while on scene.
The middle passenger in Unit#1 was transported to receive medical attention.
Unit#1 was interviewed by Officer Catalan due to the language barrier. Unit#1 told Catalan that they
were heading westbound on 4th AVE NE and tried to speed up to make the yellow light and that's
when they hit Unit#2. Unit#1 said all passengers had seatbelts on during the accident.
Unit#2 was only occupied by the driver; they told me the following: They were traveling North bound
on Nile AVE NE she was turning onto NE 4th ST when Unit#1 hit the back of her vehicle. Unit#2 had
her seatbelt on when the accident occurred and did not have any visible injuries. Unit#2 was visibly
shaken up and told me that it happened so fast, she was not sure where Unit#1 even came from. Unit
#2 was asked if she needed medical and she declined.
Information was exchanged between both Units, both Vehicle were towed, and the roadways cleared.
This concludes my involvement in this case.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. W.Nelson #12789, 08/01/2023 at 2130 hours in Renton, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: WENT THROUGH A YELLOW
Motor Vehicle Unit 2
Action Code: TURNED IN FRONT OF VEHICLE 1
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. ED88766 CASE# ' 23-8784 DATE AND TIME 08/01/23 19:06
OF COLLISION
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PAGE 4 OF 4