HomeMy WebLinkAbout23-13830 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13830 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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#
COLLISION.. 12 - 1-- 2023 1040 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067470957 0 7 30
6 LAST NAME MENDOZA OROCIO FIRST NAME EDUARDO MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 12437 TUKWILA INTERNATIONAL B APT 8 CITy TUKWILA ST WA 2jp, 981682599 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 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CB V6523 sTArI WAvIN# KMHDH4AE9CU290159
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2012 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 9 34
13 4 HYUN ELANTR DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO EDUARDO MEN .OROCIO 12437TUKWILAINTERNATIONAL B TUKWILA WA 98168 D:2067470957 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 958347457 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv YES No CITATION# 3AO827236 FOLLOWING TOO CLOSE TO FIRE o eorrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064550708
16 a
LAST NAME JOHNSON FIRST NAME LISA MIDDLE A
INITIAL
17 STREET I❑ S❑' 7633 S 113TH ST CITY' SEATTLE ST WA ZIP 981783237 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NoF,/
19 D IVERI #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS NECK PAIN
❑21❑ PLATE# BJX4165 TArE 41
WA YIN# WDCGG8J84EG166989 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2014 MAKE MERZ MODEL GLK STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LISA JOHNSON 7633 S 113TH ST SEATTLE WA 98178 D:2064550708 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIAIN BILITY
INSURANCE &POINSURGY#E CO AAA INSURANCE AB80012821 1 9TOP
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES N(�
25❑ J s a
7PLANTAGNE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
12575 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE27427
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13830
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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.
P.LANTAGNE 12-03-23 08:17 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 12/6/2023 12:04:01 PM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 10:49 AM TIME POLICE ARRIVED',10:54 AM
PART I PAGE IT]OF 4�
REPORT NO. EE27427 CASE# 23-13830 OF COLLISION
12/02/23 10:40
OF CbLLI510N
NARRATIVE
23-13830
On 12/02/2023 at approximately 1040 hours, I, Officer Lantagne, responded to a blocking, possible
injury collision which occurred on Rainier AVE EXT to the west of the Rainier AVE S intersection,
which is located in the City of Renton, County of King, and the State of Washington. I responded in
my fully marked police vehicle, wearing my patrol uniform.
I arrived on scene and observed Unit#1, a 2012 Hyundai Elantra with license plates CBV6523 issued
out of Washington State, and Unit#2, a 2014 Mercedes-Benz GLK with license plates BJX4165,
blocking an eastbound lane to the west of the intersection. I was advised the driver of Unit#2 had
neck and head pain from the collision and the Renton Fire Department responded for an evaluation.
I contacted the driver of Unit#1, Eduardo Mendoza-Orocio (DOB 08/10/1998), who told me the
following: Mendoza-Orocio was driving eastbound in the far-left lane of Rainier AVE EXT. As
Mendoza-Orocio approached the intersection, he observed traffic in front of him come to a stop for a
red light. Mendoza-Orocio pushed his brakes but could not stop his vehicle in time. Mendoza-Orocio's
vehicle struck the rear end of Unit#2.
1 contacted the driver of Unit#2, Lisa A. Johnson (DOB 10/12/1966), who told me the following:
Johnson had just stopped her vehicle for traffic in the far-left eastbound lane of Rainier AVE EXT at
the intersection of Rainier AVE S. After Johnson stopped her vehicle, the rear end of her vehicle was
struck by Unit#1.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant damage to the front bumper and hood which
was crumpled in. Unit#2 had significant damage to the rear bumper and rear door.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Johnson and Mendoza-Orocio. I issued Mendoza-Orocio an
infraction for following too closely.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0828 hours on 12/03/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EE27427 CASE# 23-13830 DATE AND TIME 12/02/2310:40
OF COLLISION
Case #23-13830
Raini erAVE, N,Not to Scale
a,
. LanRainier AVE EXT
Unit
Unit-
PAGE 4 OF 4