HomeMy WebLinkAbout23-1955 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-1955 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
i TRIBAL UNITS 02 STRUCK' UTILITY
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 02 - 18 - 2023 0011 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W HF j GgApyWAy
0 1 29
UNIT MOTOOR � CYDDAL ❑ OYESA✓NOESHOLDMET PHONE O 1 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY TACOMA ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8 DRIVER'S. STATE SEX.U D.Q.B. 1 1 2 32
❑ :LICENSE# MMDDYY —❑
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 H USE
Er 9 CLAY 0 NATURE OF INJURIES 2❑
3
10 9❑ P1 a PATRSNI sTATI WAVrN# JNKCV54E96M718793
TRAILER STATE TRAILER STATE
11 0 0I PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7. 33
12 0 0 VIN# UIN#'
FROM TO
VEH.YEAR 2OO6 MAKE INFI MODEL G35 STYLE SD VEHICLE TOWED 0 NOO ffBLIN T,QVyEq.BLRs y�S❑ENO✓ 1 S 34
DAMAGE ILJI tSAWkk
HICLE
13 REGISTERED OWNER INFO WALTPATTERSON2410N UNION AVE TACOMA WA 98406 VEHICLE NO. 1 ❑
❑ SHADE INDAMAGEDAREA 35
14 LIABILITY INSURANCE❑ INSURANCE E CO NA
IN EFFECT &POLICY# �1'OP
VE— CHARGE ❑ 36
LEGALLv YeS❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064840295
16 a
LAST NAME DIAZ LEAL GUADARRAMA FIRST NAME RENE MIDDLE
INITIAL
17❑ STREET NEW ADOREs7 906 GLENNWOOD AVE NE,APT 3 CITY RENTON ST WA ZIP 98056 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO
19 LDICENS STATE WA SEX M M D.O.B. 10 _ 12 _ 1992 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR g EJECT 1 WEB EET NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BZN8484 TATE 41
WA VIN# 1N4AL21E99N490428 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2009 MAKE j1//$S MODEL SQL)'/M�Q STYLE SD VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO RENE DIAZ LEAL GUADARRAMA 906 GLENNWOOD AVE NE,APT RENTONWA98056 D:2064840295 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE❑ &POLICY#E CO NONE CCdd
IN CTOP
VMILE ❑ ,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. ED37013
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1955
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LEISE TARA L
(LAST FIRST,
ADDRESS&PHONE#
4119 110TH ST SW,APT 1 TACOMA WA 98499 SEXi F MMDOYyrv1979
{� SEAT I HELMET NJURY NATURE OF INJURIES
PASSENGER ZWITNESS❑'UNIT# 1 POS. 3 AIRBAG;6 RESTR. 9 EJECT USE CLASS i7 BROKEN BONES
NAME
'(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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.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 02-18-23 02:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 2/24/2023 5:46:26 PM
BADGE OR ID# 12503 ORI# WA0171300 TIME POLICE DISPATCHED! 12:13 AM TIME POLICE ARRIVED',12:13 AM
PART I PAGE 2�OF 4�
REPORT NO. ED37013 CASE# 23-1955 OF COLLISION
02/18/23 00:11
OF CbLLI510N
NARRATIVE
RPD CASE#: 23-1955
On 02/18/2023 at approximately 0013 hours, I responded to the intersection of Rainier Ave S and S
Grady Way, in the City of Renton, King County, Washington, for a report of a two-motor vehicle traffic
accident.
Upon arrival both vehicles were parked in the middle of the intersection, located at Rainier Ave S and
S Grady Way. I identified Unit 1 as a silver 2006 Infiniti G35, bearing WA license PATRSNI
VIN#JNKCV54E96M718793. Unit 1's driver was not on scene when I arrived, but the passenger
identified by her WADOL as Leise Tara Lynn DOB (05/05/1979) was screaming that her arm was
broken. Fire arrived and evaluated Leise and determined that she was going to be transported to the
hospital. I asked Leise what happened, but she said she couldn't remember. Leise also stated that
she didn't know who the driver of Unit 1 was.
I identified Unit 2 as a 2009 silver Nissan Altima, bearing WA license BZN8484
VIN#1 N4AL21 E99N490428. Unit 2 sustained heavy damage all around the vehicle. I identified the
driver of Unit 2 via his WADL as Diaz Leal Guadarrama Rene DOB (10/12/1992). Diaz told me he
was driving southbound on Rainier Ave S approaching the intersection at S Grady Way. Diaz said he
remembered his light was green at the intersection, but he was distracted by his phone. Diaz looked
down at his phone for a second and looked up and collided with unit 1. Diaz spun around and hit a
nearby light post with the rear of his vehicle causing him to stop in place. Diaz stated that a female
driver got out of unit 1 and ran away (unknown direction of travel). Diaz stated that he was not injured
but was evaluated by fire and cleared medically due to airbag deployment.
Diaz was given the case number with my business card and both vehicles were towed from the
scene. I was unable to determine who was the at fault driver due to the driver of unit 1 fleeing from
the scene.
Once the roadway was clear, 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 02/18/2023 at 0300 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. ED37013 CASE# 23-1955 DATE AND TIME 02/18/23 00:11
OF COLLISION
Unit
Unit 2
PAGE 4 OF 4