HomeMy WebLinkAbout22-13576 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13576 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 12 - 1-- 2022 1614 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
GRANT AVE SOUTH BLOCK NO. e✓ 1600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 1000 .� FEET e S B OF S 18TH MST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4252827666 0 11
30
6� LAST NAME FULLER FIRSTNAME GABRIEL MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 7922 S.125TH ST TTLE WA
NEW ADDRESS ST zIP', 96176 2 CITY SEA
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� A5895371 sTArI WAvIN# 3FADP46J4KM149575
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
FTRL-R TPILF1 1 5 33
12 2 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2019 FORD FOCUS 4D DAMAGE vEs ONO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
2 3 4
14 2 LIABILITY INSURANCE INSURANCE CO THE GENERAL 53-WA-9935922
IN EFFECT &POLICY# 9TOP 5
VEHlcl.e CHARGE 10 BOTTOM 36
LEGALLY YES❑NO❑ CITATION# W22067727,W22067727 NO VALID OPER LICENSE WITH
15❑ STANDING 8
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES 1/ NO D:8439490670
VEHICLE CYCLE : OWNER
16 a
LAST NAME INFANTE SANTOS FIRST NAME STEVEN MIDDLE
INITIAL
17 STREET❑ NEW ADDREss❑' 1205 GRANT AVE S APT P306 CITY RENTON ST WA ZIP 980553095 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 04 25 _ 2003 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# BMF3305 TArE 41
WA VIN# STDZARFHOJS035898 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE TOYT MODEL HIGHLAN STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JORGE PACO HINOJOSA 1205 GRANT AVE S APT P306 RENTONWA98055 D:8439490670 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POLICY#E CO SAFECO H2510903IN STOP 5
'EwCLE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED19083
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13576
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.
MATTHEW NUGENT 12-27-22 11:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1212712022 1:15:22 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED'I 4:30 PM TIME POLICE ARRIVED',4:55 PM
PART I PAGE IT]OF 4�
REPORT NO. ED19083 CASE# 22-13576 OF COLLISION
12/22/22 16:14
OF CbLLI510N
NARRATIVE
22-13576
On 12/22/2022 at approximately 1644 hours, I was dispatched to a non-injury and non-blocking
vehicle collision in the 1400 block of Grant Avenue South, within the City Limits of Renton, County of
King, State of Washington.
While en route, Dispatch advised that two vehicles were involved in a collision and heavy damage
was reported.
Upon arrival, I noticed heavy mechanism and airbag deployment on one of the involved vehicles
therefore I requested Renton Fire respond for a precautionary evaluation. I contacted the involved
parties and confirmed there were no complaints of injury. Renton Fire later responded and evaluated
all involved parties at the scene. I collected each involved party's driving information and their
independent recollection of the incident.
The driver of Unit#1 stated he was the sole occupant of his vehicle and was traveling southbound in
the 1400 block of Grant Ave South in the only southbound lane of travel. The driver of Unit#1 stated
he works for Uber Eats and had just delivered to a customer at the nearby apartment complex. Upon
leaving, the driver of Unit#1 stated he was intending to continue south on Grant Ave South but due to
the snow-covered road conditions, Unit#1's rear tires began to slide out and the vehicle began
rotating clockwise. Unit#1 stated he collided with a vehicle that was approaching in the oncoming
lane. Unit#1 suffered significant damage to the rear driver's side of the vehicle.
The driver of Unit#2 stated that he was the sole occupant of his vehicle and was traveling
northbound in about the 1400 block of Grant Ave South in the only northbound lane of travel. The
driver of Unit#2 stated that he observed Unit#1 approaching his location and noticed that Unit#1
began to spin out of control. Unit#1 then collided with the front of Unit#2 causing moderate damage.
Based on the above statements, I believe the driver of Unit#1 (Fuller) was the predominant factor for
the cause of collision as Fuller was traveling too fast for the road conditions causing a collision. Fuller
was only able to produce a valid WAID at the scene of the collision but says that he recently passed
his drivers test and that it must have not updated in DOL records yet.
I issued Fuller a written warning for traveling Too Fast for Conditions and for having No Valid
Operator's License (NVOL) with Identification. Fuller was given a set number of days to provide proof
of his new driver's license to me and that if he did not comply, he would be subject to citation.
Both Unit#1 and Unit#2 had to be impounded due to extensive damage. Both involved parties were
provided a copy of the Exchange of Information.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 12/27/2022 11:22 AM Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO.! ED19083 CASE# ' 22-13576 DATE AND TIME 12/22/22 16:14
OF COLLISION
PAGE 4 OF 4