HomeMy WebLinkAbout23-12538 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12538 z
INTERSTATE ❑ CITY STREET FIRE F RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 2007 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 3RD ST BLOCK NO. e✓ 2500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e EDMONDS AVE NE
0 1 29
UNIT
MMO tOR� Z PEDAL- ElDAMAGE THRESHOLD MET PHONE
01 CYCLE YES NO 30
6� LAST NAME UNKNOWN FIRSTNAME UNKNOWN MIDDLE 1 1 2 31
INITIAL
STREET ElUNKNOWN CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
STATE SEX u D '❑- 32
LICENSE MMDYY
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10[1P1 ATNES# UNKNOWN sTAT u N# UNKNOWN
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL I STYLE TR VEHICLE TOWED fn TO VBLINJ TOWED BY GOVT.VEHICLE 1 5 34
13 4 DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO UNKNOWN UNKNOWN UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO UNKNOWN 3 4
IN EFFECT &POLICY# 9TOP
VEF" 1 5 36
LEGALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�UNIT VEHICLE ❑ CYCLE ❑ ❑
16 OWNER ❑ YES 1/ NO D:4255006060
a
LAST NAME ISSA FIRST NAME GUTIERREZ MIDDLE
INITIAL
17❑ STREET ❑', 300 VUEMONT PLACE NE#106 CITY' RENTON ST WA ZIP 98056 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❑
19F] LDI IVE # STATE SEX F M D.C.B.
01 �- 11 _ 2017 39
❑4 HELMET INJURY NATURE OF INJURIES 3 40
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT USE 2 CLASS 1 ❑
❑21❑ TATE LICENSE vIN# 41
PLATE#
42
22❑ PIR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 0 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JAREN JOKELA 12805 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE27735
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12538
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) AUST/N HARMONYC
(IAST FIRST,
ADDRESS&PHONE# D.C.B.
300 VUEMONT PLACE NE RENTON WA 98056 2067103764 SEX F MMDDYyYv 07 - 10 - 1979
PASSENGER WITNESS UNIT# ' SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
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&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.
JAREN JOKELA 11-01-23 03:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 121712023 2:18:49 AM
BADGE OR ID# 12805 OR]# WA0171300 TIME POLICE DISPATCHED; 8:08 Pry TIME POLICE ARRIVED i 8:12 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE27735 CASE# 23-12538 OF COLLISION10/31/23 20:07
NARRATIVE
Renton Case #23-12538
On 10/31/2023 at 2008 hours I was dispatched to the intersection of NE 3rd St/Edmonds Ave NE, in
the City of Renton, King County, Washington. I was responding to the call of a vehicle accident with
injury.
At approximately 2012 hours I arrived on scene and observed a small child, later verbally identified by
her mother as Melissa Gutierrez (DOB 01/11/2017), laying on the sidewalk on the southeast corner of
the above referenced intersection. A King County Sheriff's Office deputy was also on scene, verbally
identified as Deputy Crookston, and was assisting with tending to Melissa.
Fire arrived on scene shortly after my arrival. While fire tended to Melissa, I spoke with a witness,
verbally identified as Harmony C Austin (DOB 07/10/1979) who had been with Melissa when she was
struck by a vehicle. Harmony stated that her and her kids, along with Melissa, were crossing NE 3rd
St at the crosswalk. Harmony said that as she reached the south side of the road, she turned around
and saw a lifted white pickup truck run the red light, striking Melissa as she was just about to get onto
the sidewalk. Harmony stated that the white truck was traveling westbound on NE 3rd St and
estimated the vehicle was traveling around 30MPH. Harmony was not able to see the driver of the
vehicle.
As fire was evaluating Melissa, her mother arrived on scene, identified as Maria L Gutierrez (DOB
08/10/1990). Maria had received a phone call from Harmony shortly after the collision and walked to
the scene on foot. Shortly after Maria arrived on scene, fire finished their evaluation of Melissa.
Melissa did not suffer any apparent injuries from the collision seemed in good spirits once her mother
arrived on scene. I took photographs of Melissa at the scene, all photos were later uploaded to Axon
as evidence.
I provided Maria a business card and case number and all parties cleared the scene.
There is no further suspect information at this time.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. Jaren Jokela #12805, 11/01/2023 at 0214 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. EE27735 CASE# 23-12538 DATE AND TIME 10/31/23 20:07
OF COLLISION
Not to.Scab
N
NE 3rd St
r
se,
Edmonds Ave NE
PAGE 4 OF 4