HomeMy WebLinkAbout23-13611 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-13611 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER HIT F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK' TREE OR STUMP
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GowsloN 11 - 26 - 2023 2021 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 5TH PL BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑B W e HARDIEAVESW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067458789 30
6� LAST NAME MENDEZ FIRSTNAME JANICE MIDDLE M 1 2 31
INITIAL
STREET ❑ 200 SW 5TH PL,APT A204 CITY RENTON ST WA ZIP 98057 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 3 RESTR 9 EJECT 1 H U SE CLASS 6 [NATURE OF
PAIN IN ARMSRIES z❑
3
LICENSE CHY0617 STATE WA VIN# KM8K3CA37PU007469
10❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RL.R. 1 5 33
12❑ VIN#' VIN#
FROM
34
13 9 VEH.YEARN MAKE HYUN MODEL KONA STYLE SD VEHICLETOWED0NOOffBLIN TSIgWgYMEYERS VEHICLE
❑ DAMAGE IILLJJII (SciV6
REGISTERED OWNER INFO JANICE MENDEZ 200SW STH PL,APT A204 RENTON WA 98057 D:2067458789 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ UABILI INSURANCE INSURANCE CO GEICO 6134169124 4
IN EFFECT &POLICY# 9TOP
vECALLv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STAIN,DIING 8 7 6
UNIT MOTOOR ❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWN ARTY [:]EA.
NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ &POINSULICY#E CO
IN EFFECT 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# T AGENCY
26
J RAYGOZA 12503 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE24686
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13611
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'
RPD CASE#: 23-13611
On 11/26/2023 at approximately 2025 hours, I responded to Plum Tree Apartments #D, in the City of
Renton, King County, Washington, for a report of a single vehicle collision.
Upon arrival, I located a vehicle identified as a black 2023 Hyundai Kona, bearing WA license
CHY0617 VIN# KM8K3CA37P0007469 parked on the north side of the D building. The vehicle had
major damage to the front bumper, and it appeared to have collided with a nearby tree. 1 identified the
driver via her WADOL as Mendez, Janice Marie (DOB 04/28/1951). Mendez told me she was parked
on the north side of the D building securing her electric scooter into a garage before she got into her
vehicle. When Mendez got into her vehicle, she had a muscle spasm on her right leg which made her
leg stiff and caused her to push on the gas pedal. The vehicle went forward, and she collided with a
tree that was in front of her. The tree sustained minor damage and was left with a few scratches on
the trunk. Mendez stated that her arms hurt due to the airbags being deployed. Fire arrived on scene
and evaluated Mendez and cleared her medically. Mendez provided all the necessary documents and
was given my business card with the case number. Gene Meyer's Towing arrived and towed
Mendez's vehicle away from the scene.
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 J. Raygoza on 11/27/2023 at 0034 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J RAYGOZA 11-27-23 12:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 11/29/2023 7:07:23 PM
BADGE OR ID# 12503 ORI#l i WA0171300 TIME POLICE DISPATCHED 8:25 Pry] TIME POLICE ARRIVED',8:Y9 Pry]
PART I PAGE IT]OF
REPORT NO. EE24686 CASE# ' 23-13611 DATE AND TIME 11/26/23 20:21
OF COLLISION
pup
Unit I
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