HomeMy WebLinkAbout23-3709 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-3709 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 04 - 1-- 2023 0016 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S 3RD ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064820384 0 11
30
6� LAST NAME WILLIAMS FIRSTNAME NASTASIA MIDDLE C 1 1 2 31
INITIAL
STREET ❑, 3849 KLAHANIE DR SE,APT 1-20 CITY ISSAQUAH ST WA ZIP 98029 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CFV0076 sTArI WAurN# 1G1ZD5ST5JF255072
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 1 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2018 CHEV MAL/BU 4D MAKE MODEL STYLE VEHICLE TOWED 0 TO ffBLINI T GOVT.VEHICLE 5 1 34
13 DAMAGE YES NO �LII� RS YES[:] No✓
REGISTERED OWNER INFO NASTASIA WILLIAMS 3849 KLAHANIE DR SE,APT 1-20 ISSAQUAH WA 98029 D:2064820384 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI INSURANCE INSURANCE CO GEICO 6110013775 �3g
4
IN EFFECT &POLICY#VEHCLE CHARGE 36
LEGALLY Yes❑NO❑ CITATION#
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
1/ NO D:4255886980
16 a
LAST NAME LAMBARENA-DONA FIRST NAME MORGAN MIDDLE J
INITIAL
17❑ NEW STREETR 7 11917 93RD LN NE,APT 203 CITY KIRKLAND ST WA ZIP 98034 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK v�Esl I I NOF YES
t l NO�
19 DRIVER # STATE WA SEX F M.C.B. 03 _ 12 _ 2002 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR g EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BBK1901 TArE WA VIN# 41
JHMCG5653XC043456 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1999 MAKE HOND MODEL ACCORD STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO MORGAN LAMBARENA-DONA 1191793RD LN NE,APT 203 KIRKLAND WA 98034 D:4255886980 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE &POINSURGY#E CO GEICO 6047907966 Cdd
IN CTOP
'E""Le ❑ ,J� CITATION# CHARGE I BOTTOM
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. ED52130
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3709
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 04-02-23 02:49 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 411712023 5:44:56 PM
BADGE OR ID# 12503 OR]# WA0171300 TIME POLICE DISPATCHED! 12:19 AM TIME POLICE ARRIVED]12:20 AM
PART Ei PAGE 2�OF 4�
REPORT NO. ED52130 CASE# 23-3709 OF COLLISION
04/02/23 00:16
OF CbLLI510N
NARRATIVE
RPD CASE#: 23-3709
On 04/02/2023 at approximately 0019 hours, I responded to the intersection of Rainier Ave S and S
3rd St, in the City of Renton, King County, Washington, for a report of a two-vehicle collision traffic
accident.
Upon arrival both vehicles were in the middle of the intersection, located at Rainier Ave S and S 3rd
St facing north. I identified Unit 1 as a gray 2018 Chevy Malibu, bearing WA/LIC CFV0076
VIN#1G1ZD5ST5JF255072. Unit 1 sustained damage to the front of the vehicle. 1 identified the driver
of Unit 1 via her WADL as Williams, Nastasia Casiea DOB (12/05/2003). Williams told me she was in
the middle lane on Rainier Ave S going northbound towards the intersection of Rainier Ave S and S
3rd St. Williams said she had a yellow light and continued to drive pass it going northbound on
Rainier Ave S when Unit 2 collided into her as it made a left turn from Rainier Ave S towards S 3rd St.
Williams stated that she was not injured but was evaluated by fire due to airbag deployment. Williams
was cleared medically by fire. Williams handed me her license, registration and insurance but
informed me that her license was suspended but that today it was supposed to be uplifted. After I ran
her driver's license it still came back as suspended in the 3rd degree.
I identified Unit 2 as a silver 1999 Honda Accord, bearing WA/LIC BBK1901
VIN#JHMCG5653XC043456. Unit 2 sustained heavy damage to the entire vehicle. I identified the
driver of Unit 2 via her WADL as Lambarena-Dona, Morgan Jennifer DOB (03/12/2002). Lambarena
told me she was in the middle lane of travel, driving southbound on Rainier Ave S approaching the
intersection of Rainier Ave S and S 3rd St. Lambarena stated she had a green light and began to
make a left turn at the intersection to go eastbound on S 3rd St but was by Unit 1. Lambarena stated
she was not injured but was evaluated and cleared medically by fire.
Both drivers were given the case number and both vehicles were towed from the location. Williams
was advised she was the at fault driver due to not granting the right of way and for driving with a
suspended license. I advised Williams that she would receive a citation in the mail for DWLS 3rd
Degree.
Once all 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 04/02/2023 at 0300 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. ED52130 CASE# 23-3709 DATE AND TIME 04/02/23 00:16
OF COLLISION
Unit 1
300 Block S 3rd St
SW Sunset Blvd
v
u
Unit 2
m'
D
m
co
PAGE 4 OF 4