HomeMy WebLinkAbout25-4316 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF92955OLCERA
COLLISION REPORT 1591971
CASE# 25-4316 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4100 3
COUNTY RD ❑ NT&RUN CODING
PRIVATE WAY
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDLL s oN' 05 - 15 - 2025 2056 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
S 3RD P! MILE POST
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.1 FEET MILES e S 8 N e RAINIER AVE S
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2066011989 0 1 30
5 LAST NAME VALLARTA NOLASCO FIRST NAME ANTONIO MIDDLE t 1 2 31
INITIAL
STREET ] 1601 S LANE ST APT 413 CITY; SEATTLE ST WA ZIP; 981442809 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs No%/ INTERLOCKYES N6�/ YES NOF,/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 01 — 26 — 1989 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES 2
USE CLASS CHEST PAIN
LICENSE, CER8344 , 1C4PJMDSXGW285439 3
10 rl� I as ATP tt sTATE WA yIN#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR zRLR 5 1 33
12 3 5 VIN# VIN#
FROM TO
13 4 VEH.YEAR2016 MAKE JEEP MODEL CHERO STYLE SV VEHICLE TOYED NOIyS46LIN diW9YMEYER YESr`VT-IENICLE p 7 3 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO gNTONIO VALLARTA-NOLASCO 1601 SLANE ST UNIT 413 SEATTLE WA 98144 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 14 NATIONAL GENERAL 2019484030
IN EFFECT &POLICY#V""' CHARGE 36
LE,,ALLY YES❑NO❑ CITATION# <14,
15 STM ING
EDAL-
MOTOR P PEDESTRIAN PROPERTY DAM THR HONE
OLD MET P
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ nWNRR vEs�/ No D:2533263705
16�
LAST NAME ONATO FIRST NAME JARED MIDDLE J
INITIAL
17
STREET ❑ 37
NEW ADORE SS❑ 22619 112TH AVE SE CITY KENT ST, WA ZIP 980312656 4
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
CDL INTERLOCKYEs NO INTERLOCK YES No�/ YES NO
19 DRIVE #
❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE
PLATE# BSS4698 TATE WA VIN It 3CZRU6H37JG715474 41
22❑ PLATE# STATE PLAAILER
TE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2Q1$ MAKE HOND MODEL HR-V STYLE 4p/ VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYER
REGISTERED OWNER INFO JARED ONATO 11877 SE 160TH ST RENTON WA 98058 VEHICLE NO.2
SHADE IN DAGEAREA
2
LIABILITY INSURANCE[Z INSURANCE CO PROGRESSIVE 988150279
IN EFFECT &POLICY# t STOP
VEHICLE ❑ CITATION11 CHARGE to BOTTOM
L'—LY YES N
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ROBIN SMITH 12986 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF92955
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4316
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) MENDEZ RAMOS OSCAR N
ADDRESS&PHONE# D O
1601 S LANE ST UNIT 413 SEATTLE WA 981442880 2064278628 SEXi M MMDDYYYY 11 - 29 - 1994
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 1 6 4 1 USE 2 CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) DOMENDEN MAGNUS B
ADDRESS R PHONE#
92-1144 HAMS ST KAPOLEI H196707 SEX' M D 0'8• 01 _ 30 _ 2025
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# 1 2 POS. 3 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 7 LEFT NECK PFitN
NAME MIDDLE INITIAL) MOLL BOBBOTT M
(LAST,FIRST,
AQQREss a PHONE# 11501 205TH AVE E BONNEY LAKE WA 98391 2537339568 SEXI F D.O.B. 03 _ 21 _ 1969
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
ROBIN SMITH 05-15-25 10:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 5/20/2025 2:24:54 AM
BADGE OR ID# 12986 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:56 PM TIME POLICE ARRIVED i 8:56 PM
PAST B 3 aDo-3mx-attar(R1Ms) PAGE 2�OF 4
REPORT NO. EF92955 CASE# 25-4316 OF DATE AND r�N + 05/15/25 20:56
O�COLLISION
NARRATIVE
25-4316
Unless otherwise stated, the following occurred in the City of Renton, County of King, State of
Washington.
On 05/15/2023 at approximately 2056 hours, 1 was dispatched to a blocking collision with injuries at
the intersection of Rainier AVE S and S 3rd PL.
While enroute, Renton Regional Fire Authority (RRFA) responded due to the report of injuries and
airbag deployment.
Upon my arrival, I confirmed that the driver of Unit#1 was complaining of chest pain and the
passenger of Unit#2 was complaining of neck pain. RRFA was on scene and evaluated the involved
parties. While on scene, I was able to collect each involved party's information and independent
summary of the events leading up to the collision.
The driver of Unit#1 said he and his adult passenger were traveling northbound on Rainier AVE S
and failed to notice the red light at S 3rd PL. The driver of Unit#1 said he failed to stop at the red light
when he was traveling northbound through the intersection. That is when he collided with the
passenger side and rear end of Unit#2.
The driver of Unit#2 said he had a green light when he was exiting the Fred Meyer parking lot. He
was traveling eastbound across the intersection at S 3rd PL and Rainier AVE S when his vehicle was
struck by Unit#1. The impact was against the passenger side and rear of his vehicle. The driver of
Unit#2 said his minor passenger was complaining of neck pain. The passenger of Unit#2 had a
father on scene who was traveling in an unrelated vehicle, but did not witness the collision. The father
identified himself as Leo Rivera Domenden DOB: 03-02-1983 (verified Hawaii DL).
There was a witness on scene who identified herself as Bobbott M Moll DOB: 03-21-1969 (verified
WADL). Bobbott said she saw the driver of Unit#1 fail to stop for their red light as they approached
the intersection of S 3rd PL and Rainier AVE S. She saw that the driver of Unit#2 had a green light
and watched it drive from west to east through the intersection. As Unit#2 proceeded through the
intersection, Unit#1 struck the passenger side and rear of Unit#2.
Based on the above statements, 1 determined that the Driver of Unit#1 is the proximate cause for the
cause of collision for failing to stop at the red light.
Both Unit#1 and Unit#2 were towed by Gene Meyer towing due to extensive damage. An exchange
of information was provided to all involved parties.
As the scene was concluding, Leo decided he wanted an ambulance to respond to transport the
passenger of Unit#2 to Valley Medical Hospital. RRFA requested a private ambulance to the scene
and the passenger of Unit#2 was transported.
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 Robin Smith #12986 on 05/15/2025 @ 2214 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF92955 CASE# 25-4316 DATE AND TIME 05/15/25 20:56
OF COLLISION
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PAGE 4 OF 4