HomeMy WebLinkAbout23-13293 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-13293 2 0 7
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 11 - 1-- 2023 1700 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
156TH AVE SE BLOCK NO. e✓ 138900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FMILES N EET e S B E e SE 5TH PLACE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2063750559 0 6 30
6� LAST NAME DEGUZMAN FIRSTNAME LANINA MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 22634 SE 271 ST ST CITY MAPLE VALLEY ST WA 2jp, 98038 2=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]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 2❑
3
10 9❑ PI ATFBit BVM7779 sTArr WA urN#' 2T18URHE8HC835718
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 1 5 33
12 3 5 VIN#' VIN#
ROM TO
VEH.YEAR 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 1 5 TOWED BY GOVT.VEHICLE 34
13 TOYT COROL SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO CHRISTOPHER DEGUZMAN 22634 SE 271STST MAPLE VALLEYWA 98038 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE Z INSURANCE CO SAFECO INSURANCE H1869104 3 4
IN EFFECT &POLICY# 912P
VEHICLE 5 36
ECALLv YES No CITATION# 3A0788025 CHARGE DRIVE DANGEROUSLY DISTRACTED o BorroM
15❑ STANDING 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:2537975994
VEHICLE CYCLE OWNER YES NO �/
16 a
LAST NAME CAMARILLO-MENDOZA FIRST NAME ARMANDO MIDDLE IL
INITIAL
17❑ NEW STREETREs7 18853 SE 265TH ST CITY COVINGTON ST WA ZIP 98042 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 10 _ 1977 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ 41
ILICENSE PLA E# D52213C TArE WA VIN1 1GC1KYC838F193310 1
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2011 MAKE CHEV MODEL SILVERA STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ARMANDO CAMARILLO MENDOZA 18853 SE 265TH ST COVINGTON WA 98042 D:2537975994 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO STATE FARM 539 0605-EO9-47AIN 1 9TOP
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JAREN JOKELA 12805 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE21049
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13293
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.
JAREN JOKELA 11-18-23 01:28 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1111912023 3:36:10 AM
BADGE OR ID# ! 12805 OR]# WA0171300 TIME POLICE DISPATCHED; 6:09 PM TIME POLICE ARRIVED',6:21 PM
PART I PAGE IT]OF 4�
REPORT NO. EE21049 CASE# 23-13293 OF COLLISION
11/17/23 17:00
OF CbLLI510N
NARRATIVE
At 1809 hours on 1 1/1 7/2023 1 was dispatched to a non-injury, non-blocking collision at the
intersection of 156th Ave SE/SE 5th PI, in the City of Renton, King County, Washington.
Upon arrival, I contacted the two involved vehicles on SE 5th PI, directly west of 156th Ave SE. Based
on my investigation, both involved vehicles were traveling southbound on 156th Ave SE. As they
approached SE 5th PI, traffic slowed causing Unit 2 to slow as well. In doing so, Unit 1 rear-ended
Unit 2, just north of the intersection of 156th Ave SE/SE 5th P1. The driver of Unit 1 advised that she
was operating her hands-free cell phone via the steering wheel and did not observe Unit 2 slowing,
causing her to rear end Unit 2.
Both involved drivers did not have any injuries, and both declined to have fire dispatched. In
observing the vehicles, Unit 1 sustained major front-end damage and Unit 2 sustained minor damage
to the rear tow hitch. Photographs were taken of both Unit 1 and Unit 2 and all photos were later
uploaded to Axon Evidence.
I provided Unit 1 and Unit 2 with an exchange of information form and cleared the scene. Unit 1 driver
was cited for Dangerously Distracted Driving.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. Jaren Jokela #12805, 11/17/2023 at 2327 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. EE21049 CASE# ' 23-13293 DATE AND TIME 11/17/23 17:00
OF COLLISION
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