HomeMy WebLinkAbout24-468 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 24-4s8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
cowsloN 01 - 1-- 2024 2132 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE NE BLOCK NO. e✓ 1248
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES
NO ,/ D:2064834075 30
6� LAST NAME HUYNH FIRSTNAME DIEP MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 1190 UN/ON AVE NE APT 63 CITY RENTON ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 BWN3953 STATE WA V N#' 2T2BK1BA1BC088897
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
rRLR. TRLR 1 3 33
12❑ VIN If VIN#i
:: ;.... FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 2011 LEXS RX 300 SV DAMAGE vesNo ves❑ NO
REGISTERED OWNER INFO LINH BUI 1900 UNION AVENEAPT83 RENTON WA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 2719149E1447C 3 4
IN EFFECT &POLICY# 9TOP
�LEGNA'CLLL,'�yE CHARGE 1 5 36
YES No CITATION# 4AO022140 INATTENTIVE DRIVING o eorrom
15❑ NDG 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
iT 02 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER ❑ YES 1/ NO D:2065191180
16 a
LAST NAME PEREZ HERNANDEZ FIRST NAME NESTOR MIDDLE ID
INITIAL
17 STREET❑ NEW ADOREss❑' 1150 UNION AVE NE APT 5-3 CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.C... 11 � 1993 27 39
LICENSE# MMDDYY
�A—TURE OF INJURIES
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT H EET 2 LASSY 7 UNABLE TO STAND UNDER HIS OWN POWER 40
❑21❑ TATE LICENSE vIN1 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED By GOV HI 44
L4 1 6 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
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE43654
COLLISION REPORT III III III III III 111
1591972 CASE# 24-468
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GARCIA BALBUENA KARLA
(LAST FIRST,
ADDRESS&PHONE#
1150 UN/ON AVE NE APT 5-3 RENTON WA 98059 4259196592 SEXi F MMDDYyry
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS, USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 01/13/2024 at 2134 hours I was dispatched to a vehicle versus pedestrian collision at 1248 Union
Ave NE in the City of Renton, King County, Washington. When I arrived 1 observed Pedestrian 1 on
the ground next to the front drivers side bumper of Vehicle 1. The driver of Vehicle 1 stated that she
was traveling South on Union Ave NE at around the 1200 block when she was preparing to turn left
into the parking lot of the Rainier Crest Apartments. Driver 1 said that when she made the lefthand
turn to travel East into the parking lot, the front driver side bumper of Vehicle 1 made contact with
Pedestrian 1 who was on the East sidewalk on Union Ave NE. Driver 1 stated that she did not see
Pedestrian 1 on the sidewalk. Of note, I observed that the windshield of Vehicle 1 was still frosted
over, obscuring the view of Driver 1. 1 was unable to assess the extent of the injuries to Pedestrian 1
on the scene as he was wearing many layers of clothing. Pedestrian 1 did have troubles getting back
up and was unable to do so without assistance. Renton Regional Fire Authority (RFA) arrived on
scene and evaluated Pedestrian 1 who was then transported via ambulance to be further treated for
injuries. Pedestrian 1 said that he was walking South on the East sidewalk along Union Ave NE at
around the 1200 block. Pedestrian 1 said that as he walked towards the entrance to the Rainier Crest
Apartments he was struck by the front driver side bumper of Vehicle 1. This was corroborated by
Witness 1, who is the wife of Pedestrian 1.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-13-24 10:31 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 112412024 5:48:54 AM
BADGE OR ID# 112509 ORI# i WA0171300 TIME POLICE DISPATCHED 9:34 PM TIME POLICE ARRIVED f 9:36 PM
PART I PAGE IT]OF 3�
REPORT NO. EE43654 CASE# ' 24-468 DATE AND TIME 01/13/24 21:32
OF COLLISION
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