HomeMy WebLinkAbout23-10124 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-10124 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 09 - 01 - 2023 2256 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PARK AVE N BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 1 29
UNIT MOTOR
VEHICL PI CYCLE ElDDAMYESA✓NOESHOLDMET PHONE 0 11
30
6 LAST NAME LINO MARTINEZ FIRST NAME VICTOR MIDDLE A 1 2 31
INITIAL
STREET ❑, 1006 S 320TH ST K201 CITY FEDERAL WAY ST WA ZIP 98003 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR I [NATURE OF INJURIES
4 EJECT 1 H U EET 2 1 INJURY CLASS ju LOSS OF CONCIOUSNESS z❑
3
10[1P1 ATNES# BTD0126 sTAr WAu N# 5NMSH73E67H044256
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 5 34
13 4 HYUN SANTA P4 DAMAGE YES No �MEYER TOWING YES[:] No✓
REGISTERED OWNER INFO BEL.PALACIOS-GARCIA 14588 NE 7THPL,APT305 BELLEVUE WA 98007 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE N
14 ❑ UNKNOWN UNKNOWN
IN EFFECT INSURANCE CO
I&POLICY# �1'OP
VEwcLE CHARGE ❑ 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063714148
16 a
LAST NAME SALAS-SALDANA FIRST NAME ALBERTO MIDDLE
INITIAL
17 STREET I❑ S❑' 21405 29TH AVE S CITY' SEATAC ST' WA ZIP 98198 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D STATEWSEXM .CB. _ 39
# M .
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BPP8679 TArE 41
WA VIN# ZAM57RTA6F1138697 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE MASS MODEL GHIBLI STYLE P4 VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER TOWING YES NO
REGISTERED OWNER INFO ALBERTO SALAS-PALMA 2140529TH AVE S SEATAC WA 98198 D:2063714148 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE 8 POINSURGY#E CO STATE FARM 463-5914-AO6-47BIN STOP 5
vE""LE ❑ N`LJ,J� CITATION# CHARGE
LEG to BOTTOM
ALLY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED95742
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10124
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VALDEZ-SALAZAR JAMIEA
(LAST FIRST,
ADDRESS&PHONE#
24043 20TH AVE S DES MOlNES WA 98198 2063101599 SEXi F MMDDYyry 12 - OS - 2005
PASSENGER Z WITNESS❑ UNIT# 2 POS USE 2 CLASS 3 AIRBAG:6 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' '1
NAME
(LAST,FIRST,MIDDLE INITIAL) + HERNANDEZ IMELDA J
ADDRESS&PHONE# D O B
20834 13TH AVE S DES MOINES WA 98198 2063101599 SEX I F MMDDYvvv 09 _ 26 _ 2005
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 9 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 6 FACIA!LACERATION
NAME
(LAST FIR57 MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.Q.B. -
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ SEATPOS. USE CLASS DRIES �
NARRATIVE'
On 9/1/2023 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 two vehicle collision with a rollover in the intersection
of N 3rd St and Park Ave N Renton/King/WA. I arrived on scene and located one vehicle flipped onto
its roof and another stopped nearby with extensive damage. Both drivers and passengers had
removed themselves from the vehicle.
A black Hyundai Santa Fe (WA/BTD0126) was flipped on its roof, the driver was out of the vehicle.
He advised that he had lost consciousness during the collision. I directed RRFA to evaluate him and
he was cleared at the scene. There was am impact point of the Hyundai on the drivers side door.
There was no insurance provided for the vehicle and Gene Meyer Towing removed it from the scene.
A red Maserati Ghilbi was stopped nearby with extensive front end damage. The driver and front
passenger advised they were not injured. The rear passenger had a facial injury and was evaluated
and cleared by RRFA. The driver of the Maserati advised he was going southbound on Park Ave N
with a green light when the Hyundai entered the intersection from the west causing the collision. The
Maserati was removed from the scene by Gene Meyer Towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 09-02-23 12:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 9/4/2023 6:55:33 PM
BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED! 10:58 PM TIME POLICE ARRIVED 11:00 PM
PART I PAGE IT]OF
REPORT NO. EU95742 CASE# 23-10124 DATE AND TIME 08/01/2322:58