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Home My WebLink About22-13183 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 22-13183 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 12 - 1-- 2022 1905 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ N SOUTHPORT DR BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ VV a GARDEN AVE N 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2066502212 0 81 30 6❑ LAST NAME RICHARDSON FIRSTNAME BRYAN MIDDLE T 0 11 31 INITIAL STREET ❑ 7222 S 130TH ST CITY SEATTLE ST WA 21p, 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID -O B 01 1- 15 - 1983 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� BL67256 sTATe WA vIN# M39CN3S012359 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 9 9 34 13 4 1973 APO 2500 MH DAMAGE vEsNo �LII� RS YES[:] No ❑ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 923653684 3 4 IN EFFECT &POLICY# 9TOP VEHICLe 15 1 5 36 LEGALLY Yes❑NO❑ CITATION# CHARGE 1 o BOTTOM ❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:6027020872 16 a LAST NAME GUTIERREZ LOPEZ FIRST NAME JOSE MIDDLE A INITIAL 17❑ NEW STREETR 7' 12617 SE 60TH ST CITY BELLEVUE ST WA ZIP 98006 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK v�Esl I I NOF YES t l NO� 19� DRIVER # STATE WA SEX M M D.C.B. 09 _ 13 _ 1995 39 20❑ ON DUTY STATUS I AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40 ❑ILICENSE 21❑ PLA E# BVM7206 TATE WA VIN# 41 4JGDA2EBSDA209217 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2013 MAKE MERZ MODEL ML350 STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO OF BELLEVUE MERCEDES BENZ 11950 NE BEL RED RD BELLEVUE WA 98005 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU&PORGY#E CO MARSH USA INC GARH25551242IN I GD VE—LE CITATION# CHARGE 25 LEGALLY YES[Z N� ❑ J s a 7BRYAN NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26NAME 12489 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED30526 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13183 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) PORTER JAHMAAL N (LAST FIRST, ADDRESS&PHONE# D O.B. ' 673 ILWACO PL NE RENTON WA 98059 8326963379 SEX M MMDDYyry 02 - 18 - 1994 PASSENGER I�I WITNESS❑'UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT ? I HELMET LASS NATURE of INJURIES L`!1 USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.Q.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. BRYAN GROZAV 12-13-22 10:55 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 1 2/2/2023 1:51:24 AM BADGE OR ID# 1Y489 ORI# WA0171300 TIME POLICE DISPATCHED; 7:08 PM TIME POLICE ARRIVED',7:07 Pm PART I PAGE IT]OF 5� REPORT NO. ED30526 CASE# 22-13183 OF COLLISION 12/13/22 19:05 OF CbLLI510N NARRATIVE CASE 22-13183 This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. On Tuesday December 13th, 2022 at approximately 19:06, 1 responded to a 911 call regarding a three-vehicle collision in the area of N Southport Dr and Garden Ave N in the City of Renton, King County, Washington. ***CALL REMARKS: 3 VEH MVA, LINK INJURIES, BLOCKING TURN LANE TO LAKE WASHINGTON BLVD N. UNK DESC OF 3RD VEH, RP HAS DASH CAM FOOTAGE, IS AVAILABLE BY FONE CONTACT IF FOOTAGE IS NEEDED. -UNIT ONE: BLUE/WHITE 1973 APOLLO 2500 MOTOR HOME WASHINGTON LICENSE BLB7256 -UNIT ONE DRIVER: BRYAN T RICHARDSON (DOB: 1.15.1983) -UNIT TWO: SILVER 2013 MERCEDES-BENZ ML350 WASHINGTON LICENSE BVM7206 -UNIT TWO DRIVER: JOSE A. GUTIERREZ LOPEZ (DOB: 9.13.1995) -UNIT THREE: WHITE 2011 HONDA CR-V WASHINGTON LICENSE BPN1641 -UNIT THREE DRIVER: GABRIELLE MENTIS (DOB: 10.02.1993) 1 arrived on scene and contacted the involved parties near the intersection of N Southport Dr and Garden Ave N. Bryan (unit one driver) reported the following; his vehicle's brakes failed and couldn't stop as he was traveling west on N Southport Dr. He attempted to drive in between unit two and three to avoid crashing into any vehicles. Bryan's vehicle was too large to drive between unit two and three causing his vehicle to crash into both vehicles which were stopped at the red light. Bryan was not injured and the only occupant in the vehicle at the time of the collision. Unit one had minor damage to the front end of the vehicle. Unit one was towed from the scene since it was not safe to operate on the roadway due to the brake failure. After talking to Bryan, I contacted Jose (unit two driver) who reported the following; he stopped at the red light at the intersection of N Southport Dr and Garden Ave N and all of sudden was struck by unit one. Jose had a passenger identified as Jahmaal N. Porter (DOB: 2.18.1994) who was sitting in the front passenger seat at the time of the collision. Jose did not report any injuries but Jahmaal said he had back pain. Jahmaal declined medical attention. Unit two had heavy rear quarter panel damage on the passenger side. Unit two was towed from the scene since it was not drivable. Sergeant C. Tolliver contacted Gabrielle (unit three driver) who stated she was stopped in the right turn lane when unit one struck her vehicle. Gabrielle indicated she was not injured, and she was the sole occupant in the vehicle at the time of the collision. Unit three had heavy rear end damage and was towed from the scene. I provided all involved parties a SECTOR exchange of information form while on scene. 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 12.13.2022 at 22:26 hours in Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED305526 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 22-13183 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YEs NO 5 VEHICLE CYCLE OWNER ✓ D:2063691320 N:2063691320 OF 8 29 LAST NAME MENTIS FIRST NAME GABRIELLE MIDDLE INITIAL STREET 30 ❑ NEW AnDRFS10 1200 N 34TH ST CITY RENTON ST WA ZIP 98056 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO✓ NTERLOCK YES❑N0f✓ vES N ✓ DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 10 TO] - 1993 7 ON DUTY� STATUS AIRBAG' g RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BPN1641 TAr Wq VIN# 5J6RE4H33BL057836 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE If STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2011 MAKE HOND MODEL CRV STYLE UT I VEHICLE TOWS E T SABLI �d�i' anvi vEH1I' FROM TO DAMAGE YES✓NO YES NO ✓ REGISTERED OWNER INFO OWNED BY DRIVER J 9 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO GEIC04509075182 q"i"Olx IN EFFECT &POLICY# 1 VEHICLE 34 13 ❑ Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM STANDING } 7 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER RTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STREET 16 TRE "F-]' CITY ST NEW Z!P CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BRYAN GROZAV 12-13-22 10:55 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 12489 O#II,WA0171300 APTOLLIVER 2/2/2023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. ED30526 CASE# ' 22-13183 DATE AND TIME 12/13/22 19:05 OF COLLISION Lake Wash. Blvd N H NOT TO SCALE N Southport Dr r l�N1T,� 4� t Garden Ave N PAGE 5 OF 5