HomeMy WebLinkAbout23-9181 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9181 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 08 - 10 - 2023 1830 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLO
EAST VALLEYHWY CK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 43RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:7193137846 0 11
30
6� LAST NAME RODRIGUEZ FIRSTNAME DENISE MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 1440 FARNHAM PT APT 308 CITY COLORADO SPRINGS ST CO 2jp', 80904 z
NEW ADDRESS
7❑ CDL INTERLOCKYEs NOGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
i 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 2❑
USE CLASS REDNESS TO THE SIDE OF HER FACE
3
10[1 PI ATE Sif BSUA04 STATE CO VIN#' 3MZBMIL77FM211744
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# Rom ro
TRLR. TRLt2 7 3 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR 2015 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 34
13 4 MAZD MAZDA3 DAMAGE YES NO �MEYERS 1 5 YES❑ No✓
REGISTERED OWNER INFO DENISE RODRIGUEZ 1440 FARNHAM PT APT 308 COLORADO SPRINGS CO 80904 D:7193137846 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO GEICO 6134-41.63.01
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ NDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET1 —1 PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062187532
16 a
LAST NAME SY FIRST NAME JAMES MIDDLE S
INITIAL
17❑ STREET ❑' 3408 S THISTLE ST CITY' SEATTLE ST' WA ZIP 98118 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 08 _ 1965 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT ''1 USE CLASS ❑
21❑ LICENSE AEN9727 TATE WA VIN# JHLRE4H54BC018537
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE HOND MODEL CRV STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO JAMES SY 3408 S THISTLE ST SEATTLE WA 98118 D:2062187532 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE &POINSURGY#E CO STILLWATER CV8001744IN STOP 5
VE""Le ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
LACY SMITH 12613 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED91179
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9181
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(IAST FIRST,MIDDLE INITIAL) DU CHAU
ADDRESS&PHONE# D.0
.B.
SEATTLE 2062187532 SEX U MMDDYyry 04 - 08 - 1969
SEAT HELMET CLASS UNKNOWNNATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 SOS 3 AIRBAG 6 RESTR. 9 EJECT 1 USE CLASS 0
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYY
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'
The following report is a summary of the events that occurred while my AXON body-worn camera
was on and activated.
On 08/10/2023, 1 was assigned to District 13 as the, 3R13. At approximately 1836 hours I was
dispatched to a 2 vehicle collision located at EAST VALLEY HWY/SW 43RD ST. This is located in the
city of Renton, the county of King, and the state of Washington.
Unit 1-CO/ BSUA04
Unit 2- WA/AEN9727
I contacted the driver of Unit 1 and positively identified them as, Denise Rodriguez, by their Colorado
driver's license. Rodriguez stated she was traveling Eastbound on SW 43rd ST. Rodriguez stated
something along the line of, she was going straight and all of a sudden, she was in a collision.
I contacted the driver of Unit 2 and positively identified them as , James Sy, by his Washington state
driver's license. Sy stated, he was traveling south sound on E Valley Hwy. Sy stated his light turned
green and he waited a few seconds before going. Per Sy, once he began to go Unit 1, who was
traveling very quickly came through the intersection and collided with his vehicle.
From the statements made on scene, it appears Unit 1 ran the red light colliding into Unit 2 in the
intersection.
Everyone involved was evaluated by Renton Fire and medically cleared on scene. Both vehicles were
privately towed from the scene.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
LACY SMITH 08-15-23 02:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1 812012023 11:12:57 PM
BADGE OR ID# 12613 OR]#' WA0171300 TIME POLICE DISPATCHED 6:36 PM TIME POLICE ARRIVED',6:40 PM
PART I PAGE IT]OF
REPORT NO. ED91179 CASE# ' 23-9181 DATE AND TIME 08/10/23 18:30
OF COLLISION
'S
LIJ
S
7-
-a
J
N �
Unit 1'
SW 43RD ST
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This diagram is not to scale-.
Unit Paint of impact
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