HomeMy WebLinkAbout23-1487 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-1487 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
cowsloN 02 - 1-- 2023 2038 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PARK AVE N BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e N 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255208503 0 11
30
6❑ LAST NAME SMITH FIRSTNAME MICHIA MIDDLE A 1 2 31
INITIAL
STREET ❑ 1250 S PUGET DR APT H326 CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1- 04 - 1990 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aTES� BZD2903 sTArI WAurN# 3FADP4AJXGM126813
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/g[ GOVT.VEHICLE 34
13 4 2016 FORD FIESTA SD D AMA G 7 3 E YES NO YES❑ No✓
REGISTERED OWNER INFO ZACHERYKASSINGER 1250 S PUGETDR APTH326 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 960396825
IN EFFECT &POLICY# 9TOP
VE—LL RGE 1 5 36
LEGALv re5 No CITATION# 3A0171722 CHA FAIL TO OBEY TRAFFIC CONTROL o Borrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U—NIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064759681
16 a
LAST NAME OLEA PALMA FIRST NAME JOSE MIDDLE A
INITIAL
17 STREET NEW ADDREs7 679 REDMOND AVE NE CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] DRIVER #
❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BXH3670 TArE WA VIN# 41
3C4PDCA85GT230456 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2016 MAKE DODG MODEL AVENGE STYLE UT DAMAGE TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE I PORGY#E CO NATIONAL GENERAL INSURANCE 201615242201 STOP 5
IN EFFECT
VE—LE ❑ ,J� CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N J
' a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED35397
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1487
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KISSINGER AMANDA M
(LAST FIRST,
ADDRESS&PHONE#
1250 S PUGET DR APT H326 RENTON WA 98055 9166420748 SEXi F MMDOYyrv1991
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 1 POS 3 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 7 BACK NECK
NAME
(LAST,FIRST,MIDDLE INITIAL) DOLORES MORALES ANGEL D
ADDRESS&PHONE# D O B
15414 SE 128TH ST RENTON WA 98059 2064759681 SEX M MMoouvvv 11 _ 30 _ 2000
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 2 PCS 3 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) RUFF RIANA E
AooREss&PHONE# 2261 S 250TH ST KENT WA 98032 2064304671 SEX F D•O•B. 03 _ 18 _ 1995
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.
BRYAN GROZAV 02-04-23 10:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 2/19/2023 10:23:22 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED: 8:38 PM TIME POLICE ARRIVED',8:41 PM
PART I PAGE IT]OF 4�
REPORT NO. ED35397 CASE# 23-1487 OF COLLISION
02/04/23 20:38
OF CbLLI510N
NARRATIVE
CASE 23-1487
SECTOR TRAFFIC INFRACTION: 3AO171722
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 Saturday February 4th, 2023, at approximately 20:42, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of Park Ave N and N 3rd St in the City of Renton, King County,
Washington.
'CALL REMARKS: 2 MVA, AIRBAGS DEPLOYED, UNK IF INJS. NOW, 2 VEH MVA, LINK INJS,
DRIVER OF THE WHI VEH C/O CHEST PAIN. DRVR HAS CHEST PAIN FROM SEAT BELT AND
AIRBAGS. RP HAS BACK, SHOULDER AND LEG PAIN. 3 VEH ACC... AIRBAGS ARE
DEPLOYED... (1) WHI VAN, (2) BLK DODGE JOURNEY, AND (3) WHITE FORD FOCUS. RP
REPORTING 2 MVA AT INTERSECTION, BLOCKING .. INV MALE REQ AID FOR CHEST PAIN ..
CAR ALM IN BACKGROUND ... ORDENEZ, BORIS/WITN PH# 206/941-0450.
-UNIT ONE: WHITE 2016 FORD FIESTA WASHINGTON LICENSE BZD2903
-UNIT ONE DRIVER: MICHIA A. SMITH (DOB: 7.04.1990)
-UNIT TWO: GRAY 2016 DODGE JOURNEY WASHINGTON LICENSE BXH3670
-UNIT TWO DRIVER: JOSE A. OLEA PALMA (DOB: 10.01.1994)
1 arrived on scene and contacted Jose who reported the following: he was traveling east on N 3rd St
and had the green light at Park Ave N. As he proceeded through the intersection, he crashed into unit
one. Jose and his passenger Angel E. Dolores Morales (DOB:11.30.2000) were not injured. Renton
Fire Department personnel examined both Jose and Angel while on scene. Jose's vehicle was towed
from the scene due to the damages.
After talking to Jose, I contacted Michia who was still sitting inside unit one being examined by
Renton Fire Department personnel. Michia reported the following; she was traveling south on Park
Ave N and had the green light so she proceeded through the intersection but was hit by unit two.
Michia was not injured but her passenger Amanda M. Kissinger (DOB: 4.09.1991) was transported to
Valley Medical Center for further medical attention. Unit one was registered to Amanda's husband
who was not on scene but responded later. Unit one was also towed from the scene due to its
damage.
Officer R. Rivera contacted several witnesses on scene including reporting party/witness Riana E.
Ruff(DOB:3.18.1995) who indicated she was driving behind unit two east on N 3rd St and they had
the green light. When unit two entered the intersection unit one went through the red light causing the
crash.
Based on the circumstances and witness statements, it was determined Michia failed to stop at the
red light causing the crash. I issued Michia a traffic infraction for "Obedience to and required traffic
control devices" RCW 46.61.050. 1 sent the infraction to the City of Renton court for mailing.
I provided all involved parties a copy of the SECTOR exchange of information form.
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 02.04.2023 at 22:20 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED35397 CASE# 23-1487 DATE AND TIME 02/04/23 20:38
OF COLLISION
i
i
i
N 3RD ST
NOT TO SCALE
PARK AVE N
a
PAGE 4 OF 4