HomeMy WebLinkAbout23-4645 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4645 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 1 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#
GawsloN 04 - 1-- 2023 1925 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e BURNETT AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2065913792 0 11
30
6❑ LAST NAME WU FIRSTNAME SUSANNA MIDDLE 1 2 31
INITIAL
STREET ❑ 17115 SE JONES RD CITY RENTON ST WA 21p 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 01 1— 26 — 2006 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE 14 7552FZ STATE WA VIN#' JTEES42A492131121
TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 1 5 33
vIN#
12 0 0 ' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2009 TOYT HIGHLA UT DAMAGE YES NO ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE NSURANCE CO PEMCO CA 1825648 3
IN EFFECT &POLICY# 9TOP
V- CHARGE 1 5 36
LF�A�LY YEs❑NO CITATION# 3A0323862 FAIL STOP AT INTERSECTION/STOP o Borrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2066363962
16 a
LAST NAME LEMUS GONZALEZ FIRST NAME BENJAMIN MIDDLE
INITIAL
17 STREET NEW ADOREs�' 7614 NE BOTHELL WAY UNIT 21 CITY KENMORE ST WA ZIP 98028 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] DRIVER'S STATE I WA SEX M I D.Q.B. 11 11 1977 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# C33036Z TATE 41
WA vIN1 JT4TN12D1T0022226 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1996 MAKE TOYT MODEL T100 STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO YIMIIZAGUIRRE CANO 3021 S 219TH ST APT B9 DES MOINES WA 98168 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# I 9TOP 5
"F"ISLE YES Nc❑ CITATION# 3A0323863,3A0323863 CHARGE NO VALID OPER LICENSE WITH VALID o BOTTOM
EA Y
25 s 7 a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE ORID# AGENCY
26GROZAV 12489 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED54823
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4645
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WASHINGTON NIYAH
(IAST FIRST,
ADDRESS&PHONE# D O.B.
8189308259 SEX F MMDDYYYY 09 - 12 - 2005
PASSENGER RVWITNESS❑ UNIT# ! 1 POS USE 2 CLASS 3 AIRBAG 6 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Ly O
SEX MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT I 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.
BRYAN GROZAV 04-26-23 12:29 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 4/26/2023 4:50:41 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED! 7:27 PM TIME POLICE ARRIVED]7:30 PM
PART I PAGE IT]OF 4�
REPORT NO. ED54823 CASE# 23-4645 OF COLLISION
04/25/23 19:25
OF CbLLI510N
NARRATIVE
CASE 23-4645
SECTOR CITE #3A0323862-63
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 April 25th, 2023, at approximately 19:32, 1 responded to a 911 call regarding a two-
vehicle collision at the intersection of N 3rd St and Burnett Ave N within the City limits of Renton, King
County, Washington.
***CALL REMARKS: 2 VEH MVA, INSS. 1 SUBJ W/LAC TO HEAD - ASKED FOR VEH DESC, RP
SAID "OKAY" AND H/UP - CALLING BACK.
-UNIT ONE: SILVER 2009 TOYOTA HIGHLANDER WASHINGTON LICENSE: 755ZFZ
-UNIT ONE DRIVER: SUSANNA WU (DOB: 01.26.2006)
-UNIT TWO: WHITE 1996 TOYOTA T100 WASHINGTON LICENSE: C33036Z
-UNIT TWO DRIVER: BENJAMIN LEMUS GONZALEZ (DOB: 11.11.1997)
Prior to arriving on scene, Officer D. Moynihan and Officer H. Brus were already on scene and had
contacted the involved parties. I arrived a short time later and was informed by Officer D. Moynihan
that Susanna was traveling south on Burnett Ave N when unit two crashed into her in the middle of
the intersection.
I contacted Susanna who verified what Officer D. Moynihan had told me. Susanna suffered a scratch
to her forehead from the collision and received aid on scene by the Renton Fire Department.
Susanna's passenger Niyah L. Washington (DOB:9.12.2005) was not injured. Susanna's vehicle had
to be towed from the scene due to damage to the rear right wheel. Susanna indicated she would
arrange for a tow truck.
Officer H. Brus contacted Benjamin who was waiting for police contact at Williams Ave N and N 3rd
St. Officer H. Brus informed me Benjamin did not have valid insurance or a valid driver's license.
contacted Benjamin who reported he was traveling east on N 3rd St when unit one pulled in front of
him causing him to crash into it. Benjamin was not injured and did not appear to be.
I issued Susanna a citation for the following violation(s)
RCW 46.61.200-FAIL STOP AT INTERSECTION/STOP SIGN
I issued Benjamin a citation for the following violation(s)
RCW 46.20.015- NO VALID OPER LICENSE WITH VALID ID
RCW 46.30.020- OP MOT VEH W/OUT INSURANCE
I routed both traffic infractions to 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 04.26.2023 at 00:23 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED54823 CASE# ' 23-4645 DATE AND TIME 04/25/23 19:25
OF COLLISION
NOT TO SCALE
BURNETT AVE N
l
N 3RD ST
PAGE 4 OF 4