HomeMy WebLinkAbout23-12928 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE20801 170
27
COLLISION REP FIT 1591971
CASE 23-12928 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.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 CITY# ❑
cowsloN 11 - 09 - 2023 1807 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 17200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET MILES e S B W e BENSON RD S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:3602868410 0 11
30
6 LAST NAME ROSARIO RIVERA FIRST NAME ZAMARIE MIDDLE M 1 2 31
INITIAL
STREET ❑, 11925 SE 175TH ST APT C101 CITY RENTON ST WA 21p 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BFF2576 sTArI WAvIN# 5YFBURHE5HP620846
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 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 TOYT CAROLL SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE GARRISON PROPERTYAND CASUALTY 0359705837101
IN EFFECT &POLICY# 9TOP
15❑ vewcLE 5 36
LEGALLY re5�No D CITATION# 3A0736758 CHARGE FLD SIGNAL STOPS/TURNS-UNSAFE I o eorrom
STANDING 8 7 6
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4255259963
16 a
LAST NAME MUNOZ GUZMAN FIRST NAME IVAN MIDDLE G
INITIAL
17❑ NEW STREETR 11705 S
7 E 189TH PL CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YES It I NOF YES
t l NoF,/
19 DRIVER'S STATE WA SEX M O.B.D. 04 � 27 1983 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# BMG6736 TArE WA vIN 1t JM3T63MV7A0212417 41
1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
TOWED BY Gov HI 44
VEH YEAR 2010 MAKE IlggZp MODEL CX-9 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 PROGRESSIVE 932916933IN I STOP 5
VEHICLE ❑ ,.I— CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
BENJAMIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20801
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12928
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'
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.
BENJAMIN FLICK 11-09-23 07:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1111812023 1:35:55 AM
BADGE OR ID# 12825 OR]#' WA0171300 TIME POLICE DISPATCHED 6:10 PM TIME POLICE ARRIVED',6:14 PM
PART I PAGE IT]OF 4�
REPORT NO. EE20801 CASE# 23-12928 OF COLLISION
11/09/23 18:07
OF CbLLI510N
NARRATIVE
23-12928
On 11-09-2023 at approximately 1811 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision in the
17200 block of Benson Dr S.
Upon arrival I made contact with the 2 vehicles involved. Both drivers agreed upon the circumstances
that occurred. The involved units and drivers were identified as follows:
Unit 1 (WA/BFF2576) driver Zamarie M. Rosario Rivera (DOB: 09-03-1985 via WADOL)
Unit 2 (WA/BMG6736 driver Ivan G. Munoz Guzman (DOB: 04-27-1983 via WADOL)
Both involved units were initially southbound on Benson Dr S.
Unit 02 was driving in the right lane and unit 01 was driving in the left lane. Unit 01 then changed
lanes to the right and collided with the driver side of unit 02 while attempting to change lanes. Driver
Rosario Rivera told me that she did not see unit 02 when she changed lanes.
There were no apparent injuries, and no complaint of injuries with either party.
I provided both parties with a business card which contained the case number.
I observed that the damage to the vehicles was consistent with what both parties had told me.
At the conclusion of my investigation, I determined that driver Rosario Rivera had executed an
improper lane change. I confirmed with driver Rosario Rivera that her DOL address was current. I
informed her that she would be receiving a citation for the improper lane change via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 11-09-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE20801 CASE# ' 23-12928 DATE AND TIME 11/09/23 18:07
OF COLLISION
I Am
not to scale
Cr
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unit 02
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PAGE 4 OF 4