HomeMy WebLinkAbout23-12073 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12073 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 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# ❑
cawsloN 10 - 1-- 2023 1326 17 ❑.= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES EET e S ❑ E e RAINIER AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:4258791217 0 11
30
6� LAST NAME SWOPE-BERGMAN FIRSTNAME BRAYDEN MIDDLE X 1 1 2 31
INITIAL
STREET ❑, 9520HOLLYDR CITY EVERETT ST WA 21p, 982042608 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE BQA1756 sTArI WAvIN#' 19UUA66204A051848
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2004 MAKE ACUR MODEL TL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER WFO CHERYL SWOPE-JOHNSON 9520 HOLLY DR EVERETT WA 98204 D:4258791217 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4518-39.93.75 3 4
IN EFFECT &POLICY# 9TOP
ve'CLe CHARGE 1 5 36
LEGALLv Ye6❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4072021052
16 a
LAST NAME SANTOS VELEZ FIRST NAME CRUZ MIDDLE I E
INITIAL
17 STREET I❑ s❑' 9344 55 4❑TH AVE S CITY SEATTLE ST WA ZIP 981185519 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 DRIVER'S STATE WA SEX M D.Qs. 02 _ 08 _ 1966 39
LICENSE# MMDDYyC...
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# BXN6965 TArE 41
WA VIN# 5J6RM3H59EL017540 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2014 MAKE HOND MODEL CR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO�/ YES NO✓
REGISTERED OWNER INFO CRUZ SANTOS VELEZ 21525 NORTHWOOD DR LUTZ FL 33549 D:4072021052 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04061-74-58-67IN 1GQI
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`LJ
25 -TA
s � 6
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE13690
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12073
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SANTOS ALMA R
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
9344 55TH AVE S SEATTLE WA 981185519 4072021052 SEXi F MMDOYyry 10 - 21 - 1969
PASSENGER Z WITNESS UNIT# 2 PODS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
USE 'CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY 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.
P.LANTAGNE 10-22-23 03:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 1012712023 4:42:27 PM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 1:26 Pry TIME POLICE ARRIVED',4:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE13690 CASE# 23-12073 OF COLLISION
10/22/23 13:26
OF CbLLI510N
NARRATIVE
23-12073
On 10/22/2023 at approximately 1326 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred on S 2nd ST in the 200 block, which is located in the City of Renton, County
of King, and the State of Washington. I responded in my fully marked police vehicle, wearing my
patrol uniform. I was on patrol at the intersection of S 2nd ST and Lake AVE S facing southbound. I
heard a vehicle collision to my left and observed a two-vehicle collision approximately 50 feet to the
east of the intersection.
I observed Unit#1, a 2004 Acura TL with license plates BQA1756 issued out of Washington State,
and Unit#2, a 2014 Honda CR-V with license plates BXN6965 issued out of Washington State,
blocking the two left lanes of westbound S 2nd ST, which is a one-way street. 1 was advised there
were no injuries.
I contacted the driver of Unit#1, Brayden X. Swope-Bergman (DOB 03/27/2000), who told me the
following: Swope-Bergman was driving westbound on S 2nd ST in the south inside lane. Swope-
Bergman was following his GPS and needed to stop at the Safeway for fuel. Swope-Bergman turned
his signal on and attempted to turn left into the Safeway parking lot. The left side of Swope-
Bergman's vehicle was struck by Unit#2. Swope-Bergman said he did not see Unit#2.
1 contacted the driver of Unit#2, Cruz E. Santos Velez (DOB 02/08/1966), who told me the following:
Santos Velez was driving westbound in the south curb lane of S 2nd ST. As Santos Velez's vehicle
was crossing the north entrance to the Safeway parking lot, Unit#1 changed lanes and struck the
front right corner of Unit#2.
1 observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant damage to the driver's side door and front
fender which was heavily dented in and scraped. Unit#2 had significant damage to the front bumper,
hood, and passenger side fender.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Swope-Bergman and Santos Velez.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1427 hours on 10/22/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO.! EE13690 CASE# ' 23-12073 DATE AND TIME 10/22/23 13:26
OF COLLISION
Case#23-12073
0
Not to Scale- Lace AVE S
P. Lantagne#12576
Rainier Ave Unit#1
2nd St: Unit#2
PAGE 4 OF 4