HomeMy WebLinkAbout23-10792 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-10792 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
CowsloN 09 - 19 - 2023 1444 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 10700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 180 00 FEET MILES e S ❑ W e 108THAVESE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:5133993092 0 11
30
6� LAST NAME CHEEVER FIRSTNAME MACKENZIE MIDDLE E 1 1 2 31
INITIAL
STREET ❑✓ 12010 SE 186TH ST CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9� PiATE14 AG87848 STATE AZ VIN# 1GDY7RFF5G1900956
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13Fal 2016 GMC SA VANA CG DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CO OFAMERICA U-HAUL 2727 N CENTRAL AVE 3 SOUTH PHOENIXAZ 85004 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 972797134 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe YES 5 36
LEGALLY
❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES,/ NO D:2064744434
LAST NAME ROBERTO DIEGO FIRST NAME VIRGINIA MIDDLE N
INITIAL
17❑ STREET ❑', 16405 SE MAPLE VALLEY HWY#54 CITY RENTON ST WA ZIP 980580000 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C... 07 28 _ 1964 39
LICENSE# MMDDYY
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 2 EJECT 1 USE 2 CLASS NECK AND CHEST PAIN ❑
21❑ LICENSE BTP7267 TATE I WA VIN# JHMCM56693C050441
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH
YEAR 2003 MAKE HOND MODEL ACD4D STYLE P4 DAMAGE TOWED NOO✓ BLIN TOWED BY OV HYES NO,/ 44
24❑ YES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2007974113 1ULlliKOTlTlfll;0-
--SIN EFFECTVEHICLE ❑ ,.I—I CITATION# CHARGELEGALLY YES N`LJ25 NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
QU/NT TIBEAU 07691 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01545
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10792
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HORTON LOUIS L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
18713 107TH AVE SE RENTON WA 98055 3608011790 SEX M MMDOYyry 10 - 18 - 1939
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
QUINT TIBEAU 09-20-23 02:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 9/23/2023 3:54:27 AM
BADGE OR ID# 07691 OR]# ! WA0171300 TIME POLICE DISPATCHED 2:46 PM TIME POLICE ARRIVED 2:53 PM
PART I PAGE IT]OF 4�
REPORT NO. EE01545 CASE# 23-10792 OF COLLISION
09/19/23 14:44
OF CbLLI510N
NARRATIVE
23-10792
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
On 09/19/2023 at about 1446 hours I was dispatched to SE Petrovitsky RD and 108th Ave SE for a
blocking collision. I arrived at about 1453 hours to see the vehicles blocking the two center lanes of
east bound SE Carr RD just west of 108th Ave SE.
The driver of V-1 identified herself as Mackenzie Cheever with her WADL. She told me that she was
coming from the parking lot of Fred Meyer and trying to make a left turn onto westbound SE Carr RD.
The two outside lanes had stopped for her and waived her across. She was slowly creeping forward
and waiting for a vehicle that was coming from the east. Suddenly she was struck by V-2. She did
not see V-2 or where she came from.
The driver of V-2 identified herself as Virginia Roberto Diego with her WAID card. She told me that
she was coming from work at the McDonald's and had just pulled onto eastbound SE Carr Rd in the
center turn lane. She said V-1 came at a high rate of speed in front of her and she could not stop
prior to hitting it.
Louis Horton told me that he witnessed the collision from inside the Wendy's. He stated that V-1 was
actually stopped in the roadway when V-2 suddenly struck her at a high rate of speed. He thought V-
2 must have been distracted because V-1 had just been sitting there and he could not see how V-2
did not see her.
I took digital photographs of the vehicles and scene prior to having them move out of the roadway.
later uploaded them to evidence.com. Roberto Diego was examined on scene by the Renton
Regional Fire Authority for complaints of pain to her chest and neck.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
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 Q. Tibeau 09/20/23 1400 hours, Renton, WA.
PAGE 3 OF 4
REPORT NO.! EE01545 CASE# ' 23-10792 DATE AND TIME 09/19/23 14:44
OF COLLISION
PAGE 4 OF 4