HomeMy WebLinkAbout23-2647 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-2647 z 0 7
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 03 - 1-- 2023 1035 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ 1500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S PUGET DR
0 6 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064833198 0 81
30
6� LAST NAME CABANAS FIRSTNAME ETELBERTO MIDDLE F 1 1 2 31
INITIAL
STREET ❑, 1100 SUNSET BLVD NE C214 CITY RENTON ST WA ZIP 98056 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ PI ATNE 14 D276268 sTAT WAuN# 1FTRF18W71NA65310
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. TRLR. 5 1 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2001 FORD F150 PK DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14� LIABILI INSURANCE INSURANCE CO STATE FARM 5346076-001.47 3 4
IN EFFECT &POLICY# 9TOP
15❑ VEHICLE 1 5 36
LEGALLY YES�No D CITATION# 3A0255432 CHARGE INATTENTIVE DRIVING )o BorroM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO DD 2066830413
16 a
LAST NAME ORTIZ DE LAZARD FIRST NAME ARMANDO MIDDLE
INITIAL
17❑ STREET NEW ADOREss❑' 7652 NE 12TH ST CITY RENTON ST WA ZIP 98039 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NoF,/
19 DCENS IS STATE WA SEX M MMr C.B. 10 _ 20 _ 1999 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BUH8574 TATE 41
WA VIN# WDDGF88806R170597 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
Gov HI
VEH YEAR 2011 MAKE MERZ MODEL C CLA$$ STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY 44
ES YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 940044769IN 1 9TOP
VEHICLE YES N( CITATION# CHARGE i o BOTTOM
LEGALLY �
25❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MATTHEW TRAINO 12811 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED39643
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2647
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SP/GADO-VARGAS ALBERTO
(LAST FIRST,
ADDRESS&PHONE#
23840 SE 216TH ST MAPLE VALLEY WA 98038 4255294470 SEX M MMDovyry 09 - 11 - 1995
PASSENGER Z WITNESS UNIT# 1 POS. 3 AIRBAG'2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) GONZALEZ BEVERLY V
ADDRESS&PHONE# D O B
11502 25TH AVE NE SEATTLE WA 98125 2065387726 SEX'. F MMDovuvv 09 _ 25 _ 1998
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 3 AIRBAG'2 RESTR. 4 EJECT 1 USE 2 CLASS 7 COMPLAINT OFPA/NINNECK.
NAME
(LAST FIR57 MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS T�----�
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 TRAINO 03-05-23 04:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.CHRISTIANSEN 10437 31512023 5:36:39 PM
BADGE OR ID# 12811 OR]# WA0171300 TIME POLICE DISPATCHED 10:37 AM TIME POLICE ARRIVED',10:41 AM
PART I PAGE IT]OF 4�
REPORT NO. ED39643 CASE# 23-2647 OF COLLISION
03/05/23 10:35
OF CbLLI510N
NARRATIVE
On 03/05/2023 at approximately 1037 hours I was dispatched to an Injury Traffic Collision at the
intersection of Talbot Rd S and S Puget DR, within the City of Renton, County of King, State of
Washington. Dispatch advised that there were two vehicles involved with possible injuries and that
Aid had also been dispatched. The involved vehicles pulled off the road before my arrival.
The following was recorded on my department issued body camera:
The accident involved the following vehicles/parties:
Unit# 1
2001 Ford F150 -WA Plate D27626B
Driver: Etelberto F. Cabanas (01/12/1994) -Identified by his WADOL
Passenger: Alberto Spigado-Vargas (09/11/1995)- No ID
Unit#2
2011 Mercedes-Benz C Class -WA Plate BUH8574
Driver: Armando Ortiz De Lazaro (10/20/1999) -Identified by his WADOL
Passenger: Beverly V. Gonzalez (09/25/1998) -Identified by her WADOL
Upon arrival, I observed moderate damage to the left rear of the Mercedes, and minor damage to the
front right of the Ford.
I asked Cabanas to describe what had occurred. Through a Spanish interpreter, Cabanas stated that
he was driving northbound in the 1400 block of Talbot Rd S, in the right-hand (#1) lane. According to
Cabanas, he saw the Mercedes stopped at the red light and attempted to stop but was unable to do
so. Cabanas said that he tried to steer away, but his vehicle collided with the rear of the Mercedes.
Neither Cabanas nor Spigado-Vargas reported any injuries.
I asked Ortiz De Lazaro to describe what had occurred. Ortiz De Lazaro stated that he had been
heading northbound in the 1400 block of Talbot RD S and had come to a stop in the right-hand (#1)
lane for a red light. According to Ortiz De Lazaro, the light was still red when he was struck from
behind, which pushed his vehicle forward into cross traffic. Ortiz De Lazaro did not report any injuries.
Passenger Gonzales reported a sore neck, she was evaluated and cleared by an aid unit on scene.
The left rear bumper of the Mercedes sustained moderate damage. The front right bumper of the
Ford sustained minor damage.
Cabanas was issued a Notice of Infraction under RMC 10-12-25 Inattentive Driving. The infraction
and response options were explained to Cabanas, he said he had no questions.
N/F.
PAGE 3 OF 4
REPORT NO. ED39643 CASE# ' 23-2647 DATE AND TIME 03/05/23 10:35
OF COLLISION
Not To Scaie
Scene Not Observed
8
S Puget DR
Unit#2
Co
Potnt of Impact
Unit#1'
PAGE 4 OF 4