HomeMy WebLinkAbout23-12364 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12364 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
cowsloN 10 - 1-- 2023 1237 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BRONSON WAY N BLOCK NO. e✓ 1200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255259801 0 11
30
6� LAST NAME GONZALEZ FIRSTNAME MARIA MIDDLE I E 1 2 31
INITIAL
STREET ❑ 838 HARRINGTON AVE NE APT#13 CITy RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
LRIIVER # STATE WA SEX'F MM D Y' 02 - 04 -
8❑ 1983 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9� Pi AT 14 CCW4320 STATE WA VIN# 3VWC576U6KM105419
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 2 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2019 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 YOLK JETTA SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 4823284FI647C 3 4
IN EFFECT &POLICY# 9TOP
vECALLv HICLe 1 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2534780843
16 a
LAST NAME RODRIGUEZ FIRST NAME MIRIAM MIDDLE
INITIAL
17❑ STREET ❑' 4750 AUBURN WAY N APT#E108 CITY AUBURN ST' WA ZIP 98002 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19� LDI IVERS STATE WA SEX F MMor w 03 �_ 23 _ 1998 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BKA4935 TATe WA VIN# JHMES96684S022143
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY GOV HI 44
VEH YEAR 2004 MAKE HOND MODEL CIVIC STYLE $D —FEHICLE
TOWED TOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25 e
=Kl
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12598 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE14825
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12364
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'
On Saturday, October 28, 2023 at 1312 hours, I was dispatched to a two-vehicle collision in the area
of Bronson Way N and N 1st St in Renton, WA.
The following occurred within the City of Renton, King County; Unit 1 - WA/ CCW4320 was being
driven by Maria Gonzalez and was facing eastbound in the center lane of Bronson Way N waiting to
turn left into the parking lot at 1222 Bronson Way N. Unit 2 - WA/ BKA4935 was driven by Miriam
Rodriguez and was travelling westbound on Bronson Way N in the lane closest to center.
Miriam stated she was driving westbound when Unit 1 turned directly in front of her without yielding
cause the vehicle to collide. The passenger side of Unit 1 collided with the front of Unit 2.
Maria stated she was trying to turn into the parking lot and one vehicle in the westbound lane stopped
for her and she thought the other vehicle was going to stop as well but it did not stop in time when she
started the left turn.
Both vehicles sustained damage, however, neither needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 10-28-23 05:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 10/31/2023 7:14:08 AM
BADGE OR ID# 12598 ORI#' WA0171300 TIME POLICE DISPATCHED! 1:12 PM TIME POLICE ARRIVED',1:15 PM
PART I PAGE IT]OF
REPORT NO.! EE14825 CASE# ' 23-12364 DATE AND TIME 10/28/23 12:37
OF COLLISION
W
NOT TO SCALE
VEHICLES STOPPED IN IRAFFIC
M
tD
UNIT2
UNIT 1
0�50'C�
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