HomeMy WebLinkAbout25-2505 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF76238OLCERA
COLLISION REPORT 1591971
CASE# 25-2505 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL`CODIGENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL UN TS#OF SOTR" 1 1 8 28
02 WOOD SIGNPOST
i RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 03 - 19 - 2025 2027 17 =.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PARKAVEN BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e N 4TH ST
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2068804100 0 1 30
6❑ LAST NAME VENTURA ORTIZ FIRST NAME AMAIRANI MIDDLE B 1 2 31
INITIAL
STREET ] 1231 EAGLE LN S APT 5 CITY; RENTON ST WA ZIP; 98055 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCK YEs NO✓ INTERLOCICvEs NO✓ YES ND�/
g❑ DRIVER # STATE WA SEXI F MMDOYY' 07 — 15 — 2002 1 2 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE of INJURIES 2
USE CLASS LEFT LEG PAIN
LICENSE
BXH6208 STATE WA vrN# JHMGE8H57DC033384 3
10 1�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM To
rRLR zRLR. 1 1 5 33
12 0 0 VIN#' vIN#
FROM TO
13 4 VEH.YEAR2013 MAKE yOND MODEL FIT STYLE H6 DAMICLETOWED NO�iS46LIN T�VyED.6LRS GOS❑FND $ 7 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 LIABILITY INSURANCE INSURANCE CO 3
14 � PROGRESSIVE 933076483
IN EFFECT &POLICY# 9TOP
VEnicLE CHARGE t 5 36
Lec LY YES[:]NO[:] CITATION# t a 80TTOM
15❑ STMDING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:2065010457
16�
LAST NAME DELA CRUZ FIRST NAME ANTONIO MIDDLE E
INITIAL
17 F1 STREET ❑
❑ 9111 RAINIER AVE S CITY SEATTLE ST, WA ZIP 98118 q 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES No✓ jNTERLOCK YES NO✓ YEs NO I✓
19� DRIVER'S STATE WA SEXIM D.o.e. 03 20 1998 39
LICENSE# MMODYY —
20❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE I
PLATE# BTC8234 TATE WA VIN# 4T1B11HK2JU583162 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
TOWED BY GOV HI 44
VEH.YEAR 2018 MAKE TOYT MODEL CAMRY STYLE SD DAMIAGE TOWED✓ No BLIN BANKERS ves No✓
24
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2
SHADFY DAMAGEDAREA
3 4
LIABILITY INSURANCE[Z INSURANCE CO PEMCO CA 1823579
IN EFFECT &POLICY# 9TOP
vewas ❑ ,J—I CITATION CHARGE t080TTOM
,—LY YES N
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
BRYAN GROZAV 12489 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF76238
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2505
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) RUIZ-ORITZ CARLOS E
ADDRESS&PHONE#
1231 EAGLE LN S APT 5 RENTON SEXi M MMDooB YYYY 05 IT
22 - 2012
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER z WITNESS UNIT# ; 1 POS 3 AIRBAG j 6 RESTR. 4 EJECT 1 USE 1 2 CLASS ;6 NECK/BACKPAIN
:NAME
Lnsr EIRST,MIDDLE INITIAL) HUEY NGUYEN
ADDRESS&PHONE#
2066795659 SEX' M M oa eYr
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY
NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
NAME MIDDLE INITIAL) UNKNOWN INGLE
(LAST,FIRST,
ADDRESS&PHONE# 7137050118 M
SEX D.
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
Z' 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.
BRYAN GROZAV 03-20-25 12:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 312412025 2:30:12 AM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:27 Pry/ TIME POLICE ARRIVED i 8:30 PM
PART B 3 Do-3mx—attar gt 1Mfft PAGE 2�OF 4
REPORT NO. EF76238 CASE# 25-2505 O OF COLLI r�510NN + 03/19/25 20:27
COLL1
NARRATIVE
CASE 25-2505
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Wednesday March 19th, 2025, at approximately 20:47, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of Park Ave north and north 4th St within the City of Renton, King
County, Washington. Several reporting parties called 911 to report the vehicle collision.
***CALL REMARKS: 2 VEH MVA, LINK INJS. INVL PARTY CALLING, REPORTING MVC, UNABLE
TO VERIFY HER LOC - OPEN LINE. BOTH VEHS ARE ON SHOULDER ON 4TH. TALKING TO
MALE IN BKGRND, POSS SOMEONE WHO STOPPED TO HELP, SAID SHE'S BLEEDING -
STARTING AID.
Prior to arriving the on scene, the Renton Fire Department and several other officers were already on
scene. Officer K. Peterson indicated he contacted driver of unit one Amairani B. Ventura Ortiz
(DOB:7.15.2002) and passenger Carlos E. Ruiz Ortiz (DOB: 5.22.2012). Unit one was traveling south
on Park Ave north when the crash occurred. Unit one was pushed up onto the sidewalk knocking over
a street sign and damaging a water meter causing water to spray out from the pipe. Both occupants
of unit were transported to Valley Medical Center for evaluation. Amairani complained of pain to her
right leg and Carlos complain of back and stomach pain. Carlos was seated in the front right
passenger seat. Unit one sustained severe damage and was towed from the scene.
Officer J. Gall contacted the driver and sole occupant of unit two Antonio E. Dela Cruz (DOB:
3.20.1998). Officer J. Gall indicated unit two was traveling west on north 4th St when the crash
occurred. Antonio was examined by aid but did not report any injuries. Unit two sustained severe front
end damage and needed to be towed from the scene.
Both involved drivers had valid driver's licenses and vehicle insurance. I provided both drivers a
SECTOR exchange of information form. Since Amariani was transported to the hospital, Officer J.
Gall completed a SECTOR impound form for unit one.
Both involved drivers indicated they had the green light at the intersection. Officer N. Odalovic
contacted a witness Huey Nguyen on scene who indicated he was traveling south on Park Ave north
behind unit before the crash occurred. Huey reported the light was red for south bound traffic and
indicated unit one failed to stop at the red right which caused the accident. Officer N. Odalovic
indicated Huey had dash camera footage of the incident and would upload it to Evidence.com.
This concludes my involvement in this case.
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 B. Grozav#12489 on 3.20.2025 at 00:49 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF76238 CASE# 25-2505 DATE AND TIME 03/19/25 20:27
OF COLLISION> '
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