HomeMy WebLinkAbout23-9565 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-9565 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 1 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# ❑
GowsloN 08 - 19 - 2023 2320 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LAKE WASHINGTON BLVD BLOCK NO. e✓ 1200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259026555 0 81
30
6❑ LAST NAME TINAJERO FIRSTNAME CESAR MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 6947 COAL CRK PKY SE BOX 705 CITY NEWCASTLE ST WA ZIP' 98056 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 02 1- 26 - 1987 2 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 13 EJECT 2 H U SE 5 1 INJURY CLASS 6 [NATURE OF
FACEAND ARMES z❑
3
10 2� P1 ATE 14 7F7180 STATE WA VIN# JH2PC21312M310431
TRAILER STATE TRAILER STATE
11 0 0I PLATE# PLATE# FROM TO
TRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GO VT.VEHICLE 9 9 34
13 4 2002 HOMC VT600 MT DAMAGE vEs No �AWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
15 STANDING
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
❑ 8 7 6
MOTOR PEDAL- PROPERTY PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066024473
a
LAST NAME NERIDA FIRST NAME MARCELINO MIDDLE C
INITIAL
17 STREET NEW ADDREs7 22801 9OTH WAY S UNIT M105 CITY KENT ST WA ZIP 98031 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 LDIIVE STATE WA SEX M I D.MMDDW 09 _ 16 _ 1955 39
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# C38285J TATE WA VIN 41
1GCEC19X45Z315888 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
Gov HI 44
VEH YEAR 2005 MAKE CHEV MODEL SILVERA STYLE PK VEHICLE DAMAGE TOWED NOO✓ BLIN rowed By YES NO 1/
24❑ Yr
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO ALLSTATEIN 1 GD
VE—LE CITATION# CHARGE
25
LEGALLY YESZ N�
❑ J s e
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26NAME
12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED91088
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9565
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 08-20-23 01:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 812012023 4:56:49 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 11:20 PM TIME POLICE ARRIVED 11:20 PM
PART I PAGE IT]OF 4�
REPORT NO. ED91088 CASE# 23-9565 OF COLLISION
08/19/23 23:20
OF CbLLI510N
NARRATIVE
CASE 23-9565
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 Saturday August 19th, 2023, at approximately 23:20, 1 was enroute to a 911 call when I observed
a motorcycle versus a vehicle collision that had just occurred in the 1200 block of Lake Washington
Blvd N near the north entrance of Gene Coulon Park within the City limits of Renton, King County,
Washington.
-UNIT ONE: BLACK 2002 HONDA VT600 MOTORCYCLE WASHINGTON LICENSE: 7F7180
-UNIT ONE RIDER: CESAR S. TINAJERO (DOB: 2.26.1987)
-UNIT TWO: BLACK 2005 CHEVROLET SILVERADO WASHINGTON LICENSE: C38285J
-UNIT TWO DRIVER: MERCELINO C. NERIDA (DOB: 9.16.1955)
As I was driving north in the 1200 block of Lake Washington Blvd, I noticed a motorcycle on the
ground in the south bound lanes and Cesar attempting to pick it up. Cesar was bleeding from the face
and Marcelino was out of his truck trying to assist Cesar.
Marcelino said he was stopped at the stop sign on Lake Washington Blvd N at the north entrance of
Gene Coulon Park when Cesar crashed into the back of him. Marcelino was not injured, and his
vehicle had minor damage to the rear bumper. Marcelino indicated Cesar was ejected from the
motorcycle and landed in the bed of his truck.
Cesar indicated he was on his way to the airport, was not paying attention, and did not see Marcelino
stopped in front of him. Cesar did admit to being ejected off the motorcycle and landing in the bed of
Marcelino's truck. Cesar had a laceration on his forward and possibly a broken arm. Renton Fire
arrived and triaged Cesar's injuries. Cesar's motorcycle was towed due to the damages.
All involved vehicles were provided a copy of the SECTOR exchange of information form.
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 8.20.2023 at 01:05 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED91088 CASE# ' 23-9565 DATE AND TIME 08/19/23 23:20
OF COLLISION
NOT TO SCALE NORTH ENTRANCE GENE COULON
i
1200 BLOCK LAKE WASHINGTON BLVD N
PAGE 4 OF 4