HomeMy WebLinkAbout23-12465 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12465 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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#
cawsloN 10 - 1-- 2023 1551 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ 1200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a OAKESDALE AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO �/ D:2067926167 0 9 30
6� LAST NAME SMITH FIRSTNAME GERALD MIDDLE W 1 1 2 31
INITIAL
STREET ❑ 30528 52ND AVE S CITY AUBURN ST I WA Zlp 980012729 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 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C78793K sTArI WAvIN# 1GCHC24UO3E317044
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2003 CHEV SILVER FB DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO INC PEGASUS NORTHWEST7404 S 262ND ST KENT WA 98032 D:2067926167 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 4
14 LIABILITY INSURANCE ALLMERICA FINANCIAL BENEFIT INS.CO.AW2D39621306
LI EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# W23067360 INATTENTIVE DRIVING <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL-UNI ❑ ❑ PROPERTY ❑ DAM THR OLD ME HDON
T 02 VEHICLE ❑ PEDESTRIAN E5 34800329
16 a CYCLE OWNER YSNO 2
LAST NAME MERCADO GONZALEZ FIRST NAME ROSA MIDDLE
INITIAL
17❑ NEW ADDRE STREET — 22440 BENSON RD S#E9 CITY KENT ST WA Zip 98031 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES
F% NO❑
19 LDI IVER # STATE WA ]SEX IF M .C... 02 _ 21 1979 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 WEB SET 2 NJAU SY 6 C/O NECK PAIN�TRANSPORT TO VMC BYAMB. ❑ 40
❑ILICENSE 21❑ PLA E# BWB2366 TArE 41
WA VINIi JF1GJAC66CH014577 1
42
22❑ PLATILER E# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2012 MAKE SUBA MODEL ►MPREZA STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO JONATHAN MORALES MERCADO 10608 SE 250TH PL UNITA202 KENT WA 98030 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES NEB
25❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
MATTHEW NUGENT 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE15386
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12465
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MERCADO GONZALEZ GUADALUPE
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
2207 SW 334TH PL APT R5 FEDERAL WAY WA 980232862 2534800329 SEXi F MMDOYyry 07 - 01 - 1973
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑!UNIT# 2 POS� I AIRBAG 2 1 RESTR. 4 EJECT 1 USE 1 2 CLAS5 6 C/O NECK PAIN.TRANSPORT TO
VMCRYAMB
NAME
'(LAST FIR MIDDLE INITIAL)
ADDRESS&PHONE# D 0.8
SEX MMDDYVYv
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
MATTHEW NUGENT 10-30-23 05:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
Co.JOHNSON 0505 111112023 2:38:46 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 3:54 PM TIME POLICE ARRIVED 4:02 Pry
PART I PAGE IT]OF 4]
REPORT NO. EE15386 CASE# 23-12465 OF COLLISION
10/30/23 15:51
OF CbLLI510N
NARRATIVE
23-12465
On 10/30/2023 at approximately 1554 hours, I was dispatched to an unknown-if-injury and blocking
vehicle collision at the intersection of SW Grady Way and Oakesdale Ave SW, within the City Limits
of Renton, County of King, State of Washington.
While en route, Dispatch advised the involved vehicles were blocking the westbound right lane of SW
Grady Way. Dispatch later provided an update that there were complaints of injury from the involved
parties and that the Renton Regional Fire Authority (RRFA) would also be responding.
Upon arrival, I confirmed there were complaints of neck and back pain from both the driver and
passenger of Unit#2. There were no complaints of injury from the driver of Unit#1. There, I collected
each of the involved parties driving documents and their independent recollection of the events
leading up to the collision.
The driver of Unit#1 said he was the sole occupant of his company vehicle and was traveling
westbound in about the 1200 block of SW Grady Way approaching the intersection of Oakesdale Ave
SW in lane 1 of 2. The driver of Unit#1 stated he was traveling directly behind Unit#2. The driver of
Unit#1 stated that his direction of travel had received a recent green light and therefore he began to
proceed. The driver of Unit#1 stated that Unit#2 had begun moving forward but came to a stop for
something in the roadway. Unit#1 was unable to stop in time subsequently colliding with the rear of
Unit#2 causing minor damage to the front of Unit#1. The driver of Unit#1 denied being distracted by
anything at the time of collision.
There was a language barrier and an injury being attended to by RRFA for the driver of Unit#2,
however per a passenger, Unit#2 was also traveling westbound in about the 1200 block of SW Grady
Way approaching the intersection of Oakesdale Ave SW in lane 1 of 2. Unit#2 had stopped traffic
and that while stopped, Unit#1 collided with the rear of Unit#2 causing moderate damage to the rear
of Unit#2.
A DOL records check determined that the driver of Unit#2 was listed as `Not Licensed -Eligible'.
Based on the above statements, I determined that the Driver of Unit#1 (Smith) was the predominant
factor for the cause of collision due to inattention causing a collision. I issued Smith a written warning
for Inattention. I issued the driver of Unit#2 a verbal warning for operating a motor vehicle with no
valid operator's license with ID.
Both Unit#1 and Unit#2 were able to be driven away without further incident. An exchange of
information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 10/30/2023 5:03 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO.! EE15386 CASE# ' 23-12465 DATE AND TIME 10/30/23 15:51
OF COLLISION
w
Unit 42 Unit#1
(6 Jr
'Dogeam not to scab "ZS
N
Q)
(6
0
SW Grady Way
PAGE 4 OF 4