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Home My WebLink About23-06953 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET ❑ FIRE ❑ CASE#� 23-06953 2 RESULTED 1 STOLEN STATE ROUTE � OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#OF OBJECT ❑2$ i TRIBAL 1 03 STRUCK CULVERT RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# CowsloN 06 - 19 - 2023 0034 17 . N E IN� S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MAPLE VALLEY RD/SR BLOCK NO. e✓ 14900 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 149 AV SE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4253510673 30 6 LAST NAME ROJAS VEGARA FIRST NAME JENARO MIDDLE 1 2 31 INITIAL STREET ❑ 32889 CEDAR AVE SE CITY BLACK DIAMOND ST WA ZIP 98010 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U EET CLASS ,6 FACIAL LACS/CONTUSIONS 2❑ 3 10❑ PI ATNE 14 C10738Y sTAr WAv N# 1 GT49WEYONF104629 TRAILER STATE TRAILER STATE11 5 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12❑ vIN#' UIN# FROM 34 13 4 VEH.YEAR 2O22 MAKE GMC MODEL SIERRA STYLE 4C VEHICLE TOWED No pLSABLIN TQ yEq.BLRs YES[:] No ❑ DAMAGE ILJI tSA1Wl6 REGISTERED OWNER INFO JENARO ROJAS VEGARA 32889 CEDAR AVE SE BLACK DIAMOND WA 98010 D:4253510673 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO NONE IN EFFECT &POLICY# �1'OP ve EFFECT CHARGE BOTTOM ❑ 36 LEGALLY YES❑NO CITATION# 3A0350465,3A0350465 SPEED TOO FAST FOR CONDITIONS, 15❑ NDING UNIT U2 VEHICCLE MOTR El PEDAL- PROPECYCLE ❑ PEDESTRIAN ❑ OWNERRTY ❑ DYES NO TFIROLD MET PHONE 16❑ LAST NAME CITY OF RENTON FIRST NAME MIDDLE INITIAL 17❑ STREET ❑', 1055 S GRADY WAY CITY RENTON ST WA ZIP 98055 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES t t- l NO❑ 19 LLIICENS # STATE SEX U MMDDYY -❑_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ LICENSE TArE VIN# 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ &POINSULICY#E CO IN EFFECT 9TOP 5 vE"LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES Nu 25 s � e =HSU AME(PRINT) OFFICER PHONE BADGE OR ID# 26 12651 [V7�ENCY A0171300 PAGE 01 OF PART A 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED76219 COLLISION REPORT III III III III III 111 1591972 CASE# 23-06953 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) CADENGO A SOYURI-JUDITH (LAST FIRST, ADDRESS&PHONE# D O.B. ' 32889 CEDAR AVE SE BLACK DIAMOND WA 98010 4252699865 SEXi F MMDDYyvv 01 - 31 - 1986 {� SEAT HELMET INJURY NATURE OF INJURIES PASSENGER ZWITNESS❑ UNIT# 1 POS. 8 AIRBAG 6 RESTR. 4 EJECT 1 USE CLASS 17 LEFT SHOULDER INJURY NAME (LAST,FIRST,MIDDLE INITIAL) MUCINO HERNANDEZ MARIA D ADDRESS&PHONE# D O B 32889 CEDAR AVE SE BLACK DIAMOND WA 98010 SEX I F MMDDvvvv 01 _ 14 _ 1974 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 1 PGS $ AIRBAG 4 RESTR. 1 EJECT 1 USE CLASS 5 NE CKICHESTIBACKIHEAD NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.Q.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Single motor vehicle occupied by three persons, Unit 1. Unit 1 traveling at high rate of speed eastbound along 14900 block of Maple Valley RD SE/ SR 169. Unit 1 driver speeding excessively during inclement weather with heavy rain and standing water in roadway. Unit 1 careers into guard rail on the south side of the highway, shearing the metal railing off its numerous wooden posts and folding it on itself at least at three points, approximately 100 feet of metal railing damaged. Unit 1 then collides past railing and crashed into trees across the parallel open culvert and comes to rest atop said embankment and a concrete retaining wall to the adjoining mobile home property at 14937 Renton Maple Valley Rd SE. Unit 1 sustains major disabling damage front end along with major disabling damage to the undercarriage and roof. Unit 1 driver sustains moderate non disabling facial lacerations and contusions. Unit 1 front passenger sustains non disabling complaint of pain to shoulders. Unit 1 rear passenger sustains major disabling torso, neck, and head injuries. Unit 1 rear passenger treated on scene by Renton Fire and later transported to Valley Medical Center for further treatment. Unit 1 driver sped too fast for conditions. Unit 1 driver also did not have proof of vehicle insurance. No evidence of impairment of Unit 1 driver. Unit 1 driver cited for no insurance and speeding too fast for conditions. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 06-19-23 04:21 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 7/3/2023 6:24:23 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 12:36 AM TIME POLICE ARRIVED 12:41 AM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED7621 9 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-06953 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs NO D:2069409765 MIDDLE.. 29 LAST NAME DAVIS FIRST NAME MICHAEL INITIAL U STREET 30 NEW AnnRFSP 14937 MAPLE VALLEY HWY CITY RENTON ST WA ZIP 98058 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE I SEX M M�DDYBYv 01 - 12 - 1954 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE GLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC E FROM TO DAMAGE Y E ES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnREs.� CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 06-19-23 04:21 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 � OR ID# 12651 O#I',WA0171300 APPROVED BY T%312023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED76219 CASE# 23-06953 DATE AND TIME 06/19/23 00:34 OF COLLISION SCENE NOT TO SCALE i PAGE 4 OF 4