HomeMy WebLinkAbout23-12582 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12582 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 11 - 01 - 2023 1937 17 �. S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e SW SUNSET BLVD
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2536767077 0 4 30
6❑ LAST NAME LOBO LOBO FIRSTNAME DENIS MIDDLE H 1 1 2 31
INITIAL
STREET ❑ 11120 SE 168TH ST CITY RENTON ST WA Zlp' 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 12 1- 30 - 1976 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CHP3336 sTArI WAVIN# JHMCG55461C019121
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR 2001 MAKE MODEL STYLE VEHICLE TOWED TO BLIN $ 7 TOWED BY GOVT.VEHICLE 34
13 4 HOND ACCOR SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
VEwcLE CHARGE 10 BOTTOM 36
LEGALLY YEs❑NO CITATION# 3A0776568,3A0776568 OP MOT VEH W/OUT INSURANCE,NO
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U-NIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2063338999
16 a
LAST NAME LIN FIRST NAME YUEE MIDDLE
INITIAL
17 STREET I❑ s❑' 6130 28TH AVE S CITY' SEATTLE ST WA ZIP 98108 4❑ 37
NEW ADDREs
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX F D.C... 08 _ 08 _ 1976 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CAL5265 TArE 41
WA VIN# 4JGFBSKB4MA545310 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2021 MAKE MERZ MODEL GLE STYLE UT DAMAGE TOWED TOO✓ BLIN YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO SAFEC042487332IN 1 9TOP 5
VE."LE ❑ ,J� CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N J
s a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE21044
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12582
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
PM 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.
BRYAN GROZAV 11-01-23 10:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 1111912023 3:35:41 AM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED! 7:39 Pry TIME POLICE ARRIVED',7:39 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE21044 CASE# 23-12582 OF COLLISION11/01/23 19:37
NARRATIVE
CASE 23-12582
SECTOR CITE 3AO776568
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Wednesday November 1st, 2023, at approximately 19:39, 1 responded to a 911 call regarding a
two-vehicle collision at Walgreens located at 275 Rainier Ave S within the City limits of Renton, King
County, Washington.
'CALL REMARKS: NOW, FEM CAME INS LOCN..IS CRYING AND UPSET..UNK WHAT
HAPPENED, RP UNABLE TO GET INFO..UNK INJS. IN PLOT, 2 MVA, NI, OTHER PARTY DOES
NOT HAVE INS. FEM STILL CRYING IS AT CASH REGISTER. BRO BEANIE, PINK FUR JCKT,
BLK LEATHER PANTS, BRO UGGS, CARRYING 2 BILK BAGS AND WALMART BAG.
UNIT ONE: GOLD 2001 HONDA ACCORD WASHINGTON LICENSE: CHP3336
UNIT ONE DRIVER: DENIS H. LOBO LOBO (DOB: 12.30.1976)
UNIT TWO: GOLD MERCEDES BENZ GLE WASHINGTON LICENSE: CAL5265
UNIT TWO DRIVER: YUEE LIN (DOB: 8.08.1985)
1 arrived on scene and contacted the involved parties in the Walgreens parking lot. Both parties
reported the following; they were taking a left turn onto SW Sunset Blvd from Rainer Ave S when they
crashed into each other. Denis claimed Yuee drove out of her lane causing the crash. Yuee claimed
Denis was the one who drove out of his lane causing the crash. There were not any witnesses on
scene. Both were not injured and there was minor damage to both vehicles.
Denis indicated he did not have valid insurance and did not have is WADL on him. I ran a record
check on Denies and learned he did not have a valid license but was eligible. I issued Denis a
SECTOR citation for the following traffic violations;
RCW 46.30.020 OP MOT VEH W/OUT INSURANCE
RCW 46.20.015 NO VALID OPER LICENSE WITH VALID ID
I informed Denis he would receive his traffic citation in the mail. I provided Denis and Yuee a
business card with the case number. I was not able to print a SECTOR exchange of information form
due to my computer having technological difficulties.
This concludes my involvement in this case.
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 B. Grozav #12489 on 11.01.2023 at 22:28 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE21044 CASE# ' 23-12582 DATE AND TIME 11/01/23 19:37
OF COLLISION
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SCALENOT TO
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SW SUNSET'
RAINIER AVE S
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PAGE 4 OF 4