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HomeMy WebLinkAbout25-5747 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG08066OLCERA COLLISION REPORT 1591971 CASE�# 25-5747 2 INTERSTATE CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`OENC'Y 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TRIBAL UNITS#OF 02 TRUCK TRAFFIC SIGNAL POLE BJECT 1 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E IN cOLLIsfON' 07 - 02 - 2025 1135 17 =.= S 8 W e OF 8 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION Z NON INTERSECTION ❑ PARKAVEN BLOCK NO, e 1200 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET e S 8 W e 757 WAY 0 1 29 MOTtlR PEDAL- DAMAG THRESHOLD MET PHON UNIT 01 E UEHiOLE ❑ CYCLE ❑ YES No �/ D:2534936398 30 6 LAST NAME CRUZ-JACKSON FIRST NAME JONATHAN MIDDLE R 1 2 31 INITIAL STREET ❑ 22508 45TH AVE E NEW ADDRESS CITY SPANAWAY ST WA ZIP 983876974 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO W/ INTERLOCKYEs Na✓ YES F NoF,/ 8 LCEVER'SENSE# STATE WA SEX MMDrYY' O6 32 9 ON DUTY STATUS AIRBAG 1 RESTR 2 EJECT 1 N USEET 2 1 INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, 0160102806 sTArE VIN# 0160102806 3 10 PI ATF# 11 TRAILER STATE TRAILER ,STATE 11 2 5 PLATE# PLATE# FROM TO TRLR TRLri 7 3 33 12 VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY VT,VEHICLE 13 4 2020 OTH FORK FL DAMAGE YES NO ✓ YES NO✓ m 34 REGISTERED OWNER INFO SKANSKA USA BUILDING INC 400 FAIRVIEWAVE N SEATTLE WA 98109 D:2534936398 N:2067628000 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE INSURANCE CO SKANSKA USA BUILDING SELF-INSURED 3 4 IN EFFECT &POLICY# 4TOP CHARGE 5 36 Lemur yes❑NO❑ CITATION# 7 o BOTTOM 15❑ STANDING B 7 e EDAL-. ❑ PROPERTY R PHONE PEDESTRIAN O D:42 54307500UNIT 02 VME©HTIOCRLE ❑ CYCLE DINNER 16❑ LAST NAME RENTON FIRST NAME CITY OF MIDDLE' INITIAL STREET ❑ 17 '❑ 1055 S GRADY WAY CITY RENTON ST, WA ZIP 98057 4 37 NEW AbORESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 38 INTERLOCKYES No jNTERLO RYES NQ YES ND 19[ LICEENSE# STATE SEX U MMDDYY —= � 39 HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASSLICENSE ❑ 21 PLATE# TATE 'l # 41 22❑ [TILER TRAILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP vemae ❑ ,.I—I CITATION# CHARGE tO BOTTOM A r YES N`LJ 25 a a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY WA0171300 26 D.NELSON 12421 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG08066 COLLISION REPORT III III III III III 111 1591972 CASE# 25-5747 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INTTIAL) ADDRESS&PHONE# SEX' D.O.B. — [----------� MMDDYYYY PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. — L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j 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. D.NELSON 07-03-25 05:27 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.LEVERTON 2517 7/9/2025 7:33:24 AM BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:40 AM TIME POLICE ARRIVED 11:42 AM PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47 REPORT NO.` EG08066 CASE# 25-5747 O COLLI COLLISION TIME OF 07/02/25 11:35 COLLI NARRATIVE 25-5747 ACC On 7/2/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the City of Renton. I was dispatched to a report of a vehicle versus light pole collision near the intersection of Park Ave N and Logan Ave N Renton/King/WA. It was reported that a traffic signal was damaged and there were no injuries. I arrived on scene and located the collision in the intersection of Park Ave N and 757th Way. I located the driver of the 2020 JLG 1255 Forklift SN/0160102806 #22032 owned by Skanska Building USA. The driver, identified by his WADL as Johnathan R Cruz-Jackson DOB: 6/16/1997, said that he was driving west on 757th Way crossing Park Ave. He said that he had a load of rebar attached to the forks with straps. He said that he had the boom extended as he crossed the intersection when he struck the streetlight. Johnathan was not injured. The pole and both streetlights on the pole were damaged, parts had fallen to the ground. The pole that extended over 757th Way was bent backwards as well. Skanska employees had coned off the area and advised they had called Renton City Shops to respond. I also had RPD Records calls Renton City Shops to respond to the intersection and fix the lights. Skanska employees advised they were going to stay on scene until Renton City employes responded to fix the light. It did not appear as if there was any damage to the forklift. Nothing further. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. D. Nelson #191 7/2/2025 Renton WA PAGE 3 OF 4 REPORT NO. EG08066 CASE# 25-5747 DATE AND TIME i 07/02/25 11:35 OF COLLISION t t •}9� Yl 2 St �k r §' 7'lw� i 2s y� 1 A s 't x rr, s 4 �ti l r �t� r � PAGE 4 OF 4