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Home My WebLink About24-629 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 3 27c COLLISION REP FIT 1591971 ❑ RESULTED ❑ CASE 24-629 z INTERSTATE CITY STREET FIRE 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ RESERVATION STRUCK 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑ COLLISION.. 01 — 18 — 2024 1520 17 ❑.❑ N E IN S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 116TH AVE SE BLOCK NO. e✓ 16000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 8❑ 1201. 00 FEET MILES e S B W e S 162ND ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4256520182 0 11 30 6� LAST NAME GOMEZ FIRSTNAME ELEAZAR MIDDLE V 1 2 31 INITIAL STREET ❑ 16407116TH AVE SE CITY RENTON ST WA 2jp 980585241 2= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ DRIVERS E# STATE WA SEX'M MM D�Y' 05 1— 09 — 2001 2 32 LICEN [NATURE OF INJURIES 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 H U EET 7 CLASS COMPLAINT OF HEAD PAIN 2❑ 3 10� Pi ATNES14 BYW5073 STATE WA u N# WMWZB3C56EWR39178 TRAILER STATE TRAILER STATE 11 2 0 PLATE# PLATE# 1R.. ro rRLR. TRLR. 1 5 33 12 2 0 VIN#' VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13 2 2014 MNN/ COOPS 4H DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO ROBERTO GOMEZ 16417116THAVESE RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 936312513 3 4 IN EFFECT &POLICY# 9TOP VEHICLe 5 36 LEGALLY Yea❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ �_STANDING 6 MOTOR PEDAL- PEDESTRIAN 16 a PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4257389832 LAST NAME KENNEDY FIRST NAME KADYN MIDDLE E INITIAL 17❑ STREET ❑', 14108 SE 182ND ST CITY' RENTON ST WA ZIP 980586407 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DRIVER'S STATE WA ]SEX IF D.O.B. 10 _ 02 _ 2007 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE BOY2938 TATe WA VIN# 5XYPG4A30KG567221 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I VEH YEAR 2019 MAKE KJA MODEL SORENT STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO STEVEN DELIZO 1241980TH AVE S SEATTLE WA 98178 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#ECO STATE FARM 4158879 F0647BIN STOP 5 VEHICLE ES[:] —I CITATION# CHARGE i o BOTTOM LEGALLY Y N,.I 25 $ ' 7.FF1CJEO-S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HNSON 0505 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE44528 COLLISION REPORT III III III III III 111 1591972 CASE# 24-629 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) KENNEDY SARAH E (LAST FIRST, ADDRESS&PHONE# 14108 SE 182ND ST RENTON WA 980586407 SEX i X MMDOYyry 11 - 12 - 1986 PASSENGER I�IWITNESS[];UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NJURY ' NATURE ofINJURIES L�!1 USE :CLASS I1 NAME (LAST,FIRST,MIDDLE INITIAL) KENNEDY DELIZO RONAN ADDRESS&PHONE# DOB 14108 SE 182ND ST RENTON WA 98058 SEX' MMDDYvvv 04 _ 04 _ 2017 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 10 EJECT 1 USE CLASS 1 NAME LAST FIRST,MIDDLE INITIAL) KENNEDY DELIZO CHARLOTTE ADDRESS PHONE# 14108 SE 182ND ST RENTON WA 98058 SEX 08 M _ 15 _ 2019 D.O.B. MDDYYYY PASSENGER WITNESS UNIT# ! 2 SEAT g AIRBAG 2 RESTR. 10 EJECT 1 HELMET NJURY 1 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. CO.JOHNSON 01-25-24 12:43 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 1/26/2024 7:31:49 AM BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 3:25 PM TIME POLICE ARRIVED 3:29 PM PART I PAGE IT]OF STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE44528 COLLISION REPORT III III III III III 111 1591972 CASE# 24-629 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) POLINDER DENNIS L (LAST FIRST, ADDRESS&PHONE# RENTON 4253436708 SEX i U MMDOYyry 09 - 11 - 1979 PASSENGER WITNESS SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓S UNIT# POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB BEd MMDDYYYY PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B.MMDD —❑ YYYY. 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. CO.JOHNSON 01-25-24 12:43 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 1/26/2024 7:31:49 AM BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 3:25 PM TIME POLICE ARRIVED 3:29 PM PART I PAGE 3�OF❑ REPORT NO. EE44528 CASE# 24-629 OF COLLISION 01/18/24 15:20 OF CbLLI510N NARRATIVE U2 NB 116th, U1 SIB, U1 drifted into lane occupied by U2, U2 pulled to right to avoid collision. Dvr fender U1 collided with dvr quarter panel U2 On 01-18-2024 at about 1525 hours, I was dispatched to a collision in the 16000 block of 116th Ave SE in the City of Renton, County of King, Washington State. Dispatch advised there were two vehicles involved which were blocking the roadway and possible injuries. The reporting party (passenger 1-12) was pregnant and the driver of U1 was complaining of head pain. I arrived at about 1529 hours. RRFD arrived on scene and evaluated the involved parties. U1 and U2 were some distance apart and on opposite sides of the roadway. After initial contact with RRFD personnel, I instructed both drivers to move their vehicles due to safety into a parking lot to the east for further contact. The driver of U1 was identified by WA DL and admitted to driving U1. The driver complained about having a headache and believing it may have contributed to the collision. U1 was southbound in the 16000 block of 116th Ave SE when it crossed over the center line and collided with U2. I asked the driver if he lost consciousness or fell asleep just prior to the collision and he indicated he had not. The driver of U2 was identified by WA LP and admitted to driving U2. The front passenger of the U2 was family member and valid licensed driver. U2 was northbound in the 16100 block of 116th Ave SE. The driver of U2 observed U1 drift over the center line and into her lane of travel. The driver of U2 initially thought U1 would go back into the proper lane of travel but instead continued to drift slowly into her lane of travel. U2 attempted to move to the right (east) to avoid colliding with U1. U2 continued to drift out of their lane of travel and collided with U1. I observed moderate damage to the driver side fender and headlight of U1. I observed moderate damage to the driver side quarter panel of U2. The damage to both vehicles was consistent with the information provided by both drivers. The proximate cause of the collision was U1 leaving its lane of travel and entering U2's lane of travel. Were it not for the actions of U1, the collision would not have occurred. No citations or infractions issued. Report for insurance and information. PAGE 4 OF 5 REPORT NO. EE44528 CASE# ' 24-629 DATE AND TIME 01/18/24 15:20 OF COLLISION tF 'o 43 S tt u ? f 5�3ttz;z ten,�� Ilj 4V 1 y i a rc t m l ti 4}S PAGE 5 OF 5