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Home My WebLink About23-11020 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-11020 z INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4150 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 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# ❑ COLLISION.. 09 - 1-— 2023 0934 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SW 41ST ST BLOCK NO. e✓ 1010 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 1 5 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO F,/ I D:2067300151 30 6❑ LAST NAME WILLIAMS FIRSTNAME NATHANIEL MIDDLE B 1 1 2 31 INITIAL STREET ❑✓ 1010 SW 41ST ST CITY RENTON ST WA ZIP 98057 z NEW ADDRESS ]❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID -O B 09 — 10 — 1991 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9� Pi ATNSE 14 NONE STATE jl VIN# 1 FMFU18L33LA51638 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR. 0 0 33 12❑ VIN#' VIN#' FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY 13 A GOVT.VEHICLE 3 ] 34 2003 FORD EXPEDI UT DAMAGE YES NO YES❑ NO✓ REGISTERED.WNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 UABILI INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY#ve'CLe CHARGE 36 LEcnLLv Yes NO CITATION# EQ, 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE 16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ No O 4257571324 LAST NAME LOPEZ GOMEZ FIRST NAME JUAN MIDDLE A INITIAL 17 STREET NEW ADOREs7 3740 H ST NE.APT 8 CITY AUBURN ST WA ZIP 98002 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALT�RANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I t I.OF YES t t— l NO❑ 19 DRIVE # STATE SEX M M .O.B. O6 _ 21 1985 39 ON DUTY STATUS 3 AIRBAG RESTR EJECT HELMET 2 LASSY 7 HURT ARM AND HURT LEG ❑ 40 ❑21❑ LICENSE TATE 41 VIN# 1 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 24 1 ] DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO I STOP 5 VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s e OF NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 OF CUM ING 11488 WA0171300 PART A PAGE 01 OF 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE02711 COLLISION REPORT III III III III III 111 1591972 CASE# 23-11020 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX 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. TIM CUMMING 09-26-23 01:51 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.KORDEL 9676 1 9/26/2023 5:58:20 PM BADGE OR ID# 11488 OR]# WA0171300 TIME POLICE DISPATCHED 9:49 AM TIME POLICE ARRIVED',10:01 AM PART I PAGE IT]OF 4� REPORT NO. EE02711 CASE# 23-11020 OF COLLISION 09/26/23 09:34 OF CbLLI510N NARRATIVE 23-11020 On 09/26/2023 at approximately 0952 hours, I was working as a Police Officer for the city of Renton. While I was working, I was dispatched to a collision that was not blocking and there were no injuries at 1010 SW 41st St in the City of Renton, the County of King, Washington. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. According to the notes in the call, a pedestrian was hit by a vehicle in the parking lot. The pedestrian declined aid initially. The driver was still on scene but the vehicle left the area. The driver advised that he needed to take the vehicle to the shops for repairs. The driver advised the victim that he did not have insurance. The vehicle was a black pickup truck with a canopy. It was unknown what the license plate was. As I was driving to the location, I learned that the victim was now complaining of pain in his arm and legs. I arrived on scene and met with the victim, LOPEZ GOMEZ, JUAN ALBERTO (DOB 06/21/1985). He told me that his left arm and left leg was injured. I found a few scratches on LOPEZ GOMEZ'S arm and he pointed out that his left leg was injured as well. Photos were taken of his injuries and were uploaded to evidence.com. Next, I met with the driver of unit#1. Unit#1 was identified as a black 2003 Ford Expedition (No LIC#/VIN: 1 FMFU18L33LA51638). The driver was identified as WILLIAMS, NATHANIEL BROWN (DOB 09/10/1991). According to DOL records for Unit#1, the vehicle was registered to WILLIAMS. WILLIAMS told me that he did not have insurance. WILLIAMS told me that he was storing his vehicle inside the business at the location. He had an appointment to take his vehicle to the Advanced Auto Tune, 365 Rainier Ave N #13-3, Renton WA 98057. He backed out of the business and down a ramp. He checked his rearview mirror and did not see anyone. As he was backing up, he collided with LOPEZ GOMEZ who was using a leaf blower to clean the parking lot. When Unit#1 collided with LOPEZ GOMEZ, LOPEZ GOMEZ was knocked to the ground. WILLIAMS stopped the car and checked on LOPEZ GOMEZ. LOPEZ GOMEZ was upset that he was hit. WILLIAMS'S boss stayed on scene and worked with LOPEZ GOMEZ while WILLIAMS took the vehicle to the shops for the scheduled maintenance. WILLIAMS came back to the location and then stayed on scene until I arrived and met with him. WILLIAMS confirmed that the vehicle did not have license plates and that he did not have insurance. WILLIAMS'S information was run through a WACIC/NCIC/DOL records check and it was determined that WILLIAMS'S driving status was suspended in the 3rd degree. Next, I met with LOPEZ GOMEZ. LOPEZ GOMEZ confirmed that the statements made by WILLIAMS were true and correct. I collected the required information and provided all of the involved parties with my business card and the case number for their records. A video of the collision was provided by the business in the area. It was later uploaded to evidence.com. Renton Fire was called to the scene and met with LOPEZ GOMEZ. LOPEZ GOMEZ was provided with medical attention but since his injuries were minor, he was not transported to get any further medical attention. Based on all of the information collected, the statements made by the involved parties, the physical evidence collected, and the location of the collision, I determined that no crime was committed. This case is for informational purposes only. There is no further information available 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 T. Cumming #11488 on 09/26/2023 @ 1101 hours in Renton WA. PAGE 3 OF 4 REPORT NO.! EE02711 CASE# 23-11020 DATE AND TIME 09/26/23 09:34 OF COLLISION Parking lot of 1010 SW 41 st St N 23-11020 Not drawn to scale PAGE 4 OF 4