HomeMy WebLinkAbout24-4806 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-4806 2
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$
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 05 - 04 - 2024 1501 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 101
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W V LAKEAVES
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2068198785 30
6� LAST NAME SCHULTZ FIRSTNAME GREGORY MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 11436 SE 208TH ST SPC 98 CITY KENT ST I WA 2jp, 98166 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10� PI ATFBit D94374B sTATI WAvIN#' 3FTTW8E32PRA22671
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13 2023 FORD MAVERI TR DAMAGE YES NO ✓ YES❑ No✓
REGISTEREDOWNER WFO GREGORY SCHULTZ 11436 SE 208TH ST SPC 98 KENTWA98166 D:2068198785 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE U INSURANCE CO ACE AMERICAN INC COISAH10707699 3 4
IN EFFECT &POLICY# 9TOP
C
vewcLe HARGE 1 5 36
LECALLv Yes NO CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
UNIT U2 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑MOTOR ✓ OWN ARTY ❑ DYES✓ OLD MET NO PHONE
16 a
LAST NAME FOLEY FIRST NAME ELIZABETH MIDDLE A
INITIAL
17❑ NEW STREETR 18015 S
7 E RENTON MAPLE VALLEY CITY' RENTON ST WA ZIP 98058 4❑ 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 IF D.Q.B. 02 _ 13 _ 1975 39
LICENSE# MMDDYY
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT HELMET INJURY 6 NATURE OF INJURIES 40
USE CLASS CUTS ON FEET
❑21❑ TATE 41
LICENSE VIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 0 $ 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
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# T AGENCY
26
J RAYGOZA 12503 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE75202
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4806
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
PM 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 05-04-24 05:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 51812024 10:47:36 AM
BADGE OR ID# 12503 OR]# WA0171300 TIME POLICE DISPATCHED! 3:03 PM TIME POLICE ARRIVED 3:04 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE75202 CASE# 24-4806 OF COLLISION
05/04/24 15:01
OF CbLLI510N
NARRATIVE
RPD CASE#: 24-4806
On 05/04/2024 at approximately 1503 hours, I responded to 101 S 2nd St, in the City of Renton, King
County, Washington, for a report of a vehicle vs pedestrian collision.
Upon arrival I saw unit 1 a female who was later identified by her WADOL photo as Foley, Elizabeth
Anne DOB (02/13/1975) on the ground on S 2nd St near a white vehicle unit 2 identified as a white
2023 Ford Maverick WA/LIC D94374B VIN#3FTTW8E32PRA22671.
Renton fire was already on scene medically examining Elizabeth, so I approached unit 2 and
identified the driver of unit 2 as Schultz, Gregory Allen DOB (04/28/1962). 1 informed Gregory that he
was being audio and video recorded and he informed me that he was not harmed and provided me
with his license, registration and insurance. Gregory said he was driving westbound on S 2nd St on
the left lane closest to the curb approximately 25-30 mph when he heard a loud bump on the right
side of his bumper and noticed a female fall to the ground. Gregory stopped immediately and told on
viewers to call the police. Gregory remained inside his vehicle until police arrived.
Officers on scene spoke with unit 1 Elizabeth who stated that she was crossing the road on S 2nd St
towards Safeway when a vehicle hit her. Elizabeth had minor scratches on her feet and was cleared
medically by fire. Elizabeth didn't want to speak to police afterwards and said she wanted to go to the
hospital for unknown reasons and was transported soon after.
I examined Gregory's vehicle and it had little to no damage where he claimed to have struck
Elizabeth and no other damage was seen on the vehicle either. There was also no crosswalk at the
location where Elizabeth was struck therefore making me believe that Elizabeth was jay walking
through a busy road causing unit 2 to collide with her. I provided Gregory and Elizabeth with my
business card with the case number and informed Elizabeth that she was at fault due to jay walking
but decided not to cite her.
Once both parties left the area, I cleared the scene.
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 J. Raygoza on 05/04/2024 at 1645 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EE75202 CASE# ' 24-4806 DATE AND TIME 05/04/24 15:01
OF COLLISION
l 4 kY�
4 ,
PAGE 4 OF 4
