HomeMy WebLinkAbout23-13977 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-13977 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK M/SC OBJECT OR DEBRIS ON ROAD
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 12 - 05 - 2023 2004 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e S GRADYWAY
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257534870 30
6� LAST NAME VARGAS FIRSTNAME NELSON MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 10833 SE 172ND ST,APT D CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� BYG9279 sTArI WAurN# KM8J3CAt5MU378217
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLA2 1 5 33
12❑ VIN#' VIN#'
FROM
34
13 3 VEH.YEARN MAKE HYUN MODEL TUC$O STYLE 4D VEHICLE TOWED 0 TOO ffBLIN TSIgWgYMEYER YOs❑ENo-
❑ DAMAGE IILLJJII (�ciV6
REGISTERED OWNER INFO NELSON VARGAS 10833 SE 172ND ST,APTD RENTONWA 98055 D:4257534870 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO ALLSTATE 817550989 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STAIN,DIING 8 7 6
UNIT VEHIMOTCLE ❑ 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
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LLIRIVEWSTICENS # STATE SEX MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
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❑ INSURANCE
#E CO
IN EFFECT &PO I 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 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE36263
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13977
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#: 23-13977
On 12/05/2023 at approximately 2006 hours, I responded to the intersection of S Grady Way and
Rainier Ave S, in the City of Renton, King County, Washington, for a report of a single vehicle
accident. Dispatch relayed over the radio that a vehicle identified as a red 2021 Hyundai Tucson
WA/LIC BYG9279 VIN# KM8J3CAL5MU378217 was stuck on an opened manhole and blocking
traffic.
Upon arrival I located the Hyundai, and it was just north of the intersection facing south. The vehicle
was no longer stuck, and it had major damage to the front rear passenger side of the vehicle. The
vehicle was unable to move due to the damages and a tow was called to remove the vehicle from the
road. I spoke to the driver of the vehicle identified by his WADOL as Vargas, Nelson Alberto DOB
(08/11/1958) and told me he was driving south on Rainier Ave S when he collided with the top cover
of a manhole that was on the road. The cover got stuck on his front right tire and caused major
damage as he drove over it. Nelson then realized that the vehicle wouldn't move anymore and
decided to call police. I looked under Nelson's vehicle and saw the manhole cover underneath
Nelson's vehicle tire. I removed the cover and placed it back on the manhole to prevent other vehicles
from getting stuck. Nelson provided me with the proper documentation needed and I provided him
with my business card with the case number.
The Hyundai was towed from the location, and I informed Renton Front Counter about the incident so
that a city worker could check on the manhole cover and secure it in place. The manhole cover itself
was not damaged and put back on top of the manhole.
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 12/05/2023 at 0010 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 12-06-23 01:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 11112024 7:57.14 PM
BADGE OR ID# 12503 OR]#` WA0171300 TIME POLICE DISPATCHED 8:08 Pry] TIME POLICE ARRIVED I 8:08 Pry
PART I PAGE IT]OF
REPORT NO. EE36263 CASE# 23-13977 DATE AND TIME 12/05/23 20:04
OF COLLISION
j a
Manhole cover
Unit
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