HomeMy WebLinkAbout24-9851 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
24-sssl z
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑28
TRIBAL UNITS 01 STRUCK' UT/LITYPOLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. O9 - 1-— 2024 0244 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 3RD ST BLOCK NO. e✓ 3000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a JEFFERSON AVE NE
0 1 29
MOTUNIT U1 VEHIOR PI PEDAL-CLE CYCLE ❑ DESA✓NHORESHOLD MET PHONE 30
6 LAST NAME JUAREZ SANTOS FIRST NAME JACINTO MIDDLE 1 2 31
INITIAL
STREET ❑ 305 LIND AVE SW,APT 1 CITY RENTON ST WA ZIP 98057 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES 1/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 9 EJECT 1 HELMET INJURY 5 NATURE OF INJURIES z❑
USE CLASS BROKEN RIGHT FEMUR,HEAD INJURY
3
10❑ LI ENSE CLX9043 STATE WA VIN#' 5NMSH13E89H322378
I ATE 14
T STATE TRAILER STATE
11 0 0 PLATE# PLATE# Rom ro
TRLR. TRLR 7 3 33
12❑ vIN#' VIN#
FROM
34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE
13 2009 HYUN SANTA SD DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO JACINTO JUAREZSANTOS 305 LIND AVE SW,APT RENTON WA 98057 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO UNKOWN
IN EFFECT &POLICY# �1'OP
VEwcLE CHARGE ❑ 36
LEGALLY Yes❑NO❑ CITATION# BOTTOM
15❑ STAIN,DIING
UNIT U2 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERMOTOR PEDAL- YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 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 MMODYY -❑_ 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
UIN#. '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 IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J RAYGOZA 12503 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF21204
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9851
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.
J RAYGOZA 09-20-24 04:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THiELMAN 11462 101412024 3:36:33 AM
BADGE OR ID# 12503 OR]# WA0171300 TIME POLICE DISPATCHED; 2:46 AM TIME POLICE ARRIVED:2:50 AM
PART I PAGE IT]OF 4�
REPORT NO. EF21204 CASE# 24-9851 OF COLLISION
09/20/24 02:44
OF CbLLI510N
NARRATIVE
Case Number 24-9851
On 09/20/2024 at approximately 0247 hours, I was dispatched to NE 3rd St and NE 4th St within the
City of Renton, King County, Washington to an accident with injuries. Dispatch relayed over the radio
that a vehicle that was later identified as a black 2009 Hyundai Santa Fe WA/LIC CLX9043
VIN#5NMSH13E89H322378 crashed into a utility pole. The vehicle was occupied by one male who
was still inside the vehicle in the driver's seat.
On arrival I saw the Hyundai parked on the grass field just south of NE 3rd St with major damage to
the front of the vehicle. The vehicle was facing west and there were tire marks on the ground that
appeared to have been from the Hyundai. The tire marks indicated that the vehicle was traveling
eastbound on NE 3rd St prior to the collision. Another indication that the vehicle was travelling east
on NE 3rd St was from the point of impact on the utility pole that caused it to move approximately 10
feet east from it's original spot. There was also a dirt trail from the utility pole that can clearly be seen
that the pole was moved east from where the vehicle hit it. The driver of the vehicle was still in the
driver's seat and the front air bags were deployed. I identified the driver by the registered owner's
DOL photo as Juarez Santos, Jacinto DOB (09/11/1988). 1 approached the driver side door to speak
with Jacinto and I noticed that he was bleeding from the right side of his head. The front windshield
had major damage and the injury that Jacinto had on his head corresponded with the damage that
was done to the windhsield, indicating that Jacinto possibly hit his head on it. Jacinto appeared to be
dizzy and was having a hard time answering my questions. I was unable to determine if Jacinto was
under the influence due to not smelling any alcohol and because Jacinto was dizzy and unable to
answer my questions due to the injury on his head. Renton Fire arrived on scene and helped Jacinto
out of his vehicle and noticed that Jacinto's right femur was broken. Jacinto was transported to
Harborview Medical Center with non-life-threatening injuries.
Puget Sound Energy was called and notified that their power line was damaged and only holding on
due to the wires that were attached to it. Puget Sound energy arrived shortly after, and Renton City
workers were called to block the road while Puget Sound Energy employees worked on the power
line. Once Gene Meyer Towing arrived at the location and towed Jacinto's vehicle I cleared the
scene.
This concludes my involvement with this case.
I certify (declare) under the penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed J.Raygoza/12503
09/20/2024 0500 Hours Renton, WA.
PAGE 3 OF 4
REPORT NO. EF21204 CASE# 24-9851 DATE AND TIME 09/20/24 02:44
OF COLLISION
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