HomeMy WebLinkAbout23-11780 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-11780 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$
i TRIBAL UNITS 01 STRUCK TRAFFIC SIGNAL POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 10 - 15 - 2023 2103 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e S PUGET DR
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:7869994180 30
6 LAST NAME I DIAZ VAZQUEZ FIRST NAME HUMBERTO MIDDLE 1 2 31
INITIAL
STREET ❑ 10723 SW 142ND CT CITY MIAMI ST FL 2jp, 331860000 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YES No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 'NJUR 5Y 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� TDA7612 sTAT� FL vIN# 1FDAW57F31EA36579
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ vIN#' VIN#
2001 FORD F550 CQ FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO �/ YES[:] HI
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO GEICO 2517396295 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
UNIT 02 MOTO
R ❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H OLD METVEHIC PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
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 VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � e
7S/;S
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12225 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10993
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11780
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'
Renton Case #23-11780
On 10/15/2023 at approximately 2105 hours, I was dispatched to S Puget DR and Talbot RD S, in the
City of Renton, King County, Washington, for a report of an unknown-injury, single vehicle collision.
Upon arrival I identified the vehicle as a white Ford F-550 bearing a FL temporary license plate of
TDA7612. The vehicle was parked up on a grassy area on the northeast side of the intersection. The
vehicle sustained minor damage to the front left side of the vehicle and hit a "NO TURN ON RED"
street sign that was on the north side of S Puget DR.
I identified the driver via his FLDL as Humberto Diaz Vazquez (DOB 05/12/1983), and he stated he
was not injured. Diaz stated he was driving eastbound on S Puget DR approaching the intersection
and when he applied the brakes his vehicle began sliding on the wet payment. Diaz stated he lost
control of the vehicle and hit the street sign and stopped on the grassy area.
There was recent rain tonight and I have driven on S Puget DR multiple times. The roadway is slightly
down hill and very slippery even at slow speeds.
Diaz was able to move his vehicle and I provided him with my business card with the case number on
it and he left the area.
This ends my report.
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 E. Sims on 10/15/2023 at 2228 hours, in the City of Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.SIMS 10-15-23 10:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIREE SCOTT 10272 1011912023 4:47:38 PM
BADGE OR ID# 12225 ORI#' WA0171300 TIME POLICE DISPATCHED', 9:05 PSI TIME POLICE ARRIVED;9:08 PM
PART I PAGE IT]OF
REPORT NO.! EE10993 CASE# ' 23-11780 DATE AND TIME 10/15/23 21:03
OF COLLISION
el
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4a� rW
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goy +.Q a
Unit NOT TO SCALE
hJ Q
Benson Drive S
11' (Sr 515)
Talbot Rd S
S 1"5'
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