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Home My WebLink About23-4845 ITFF' "POLCERA II I !�� I III I III I IIII III II I . S 27c COLLISION REP FIT 1591971 CASE 23-4845 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 28 TRIBAL UNITS 02 STRUCK STREET LIGHT POLE RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ GowsloN 04 - 1-- 2023 2251 17 ❑.= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ PARK AVE N BLOCK NO. e✓ 400 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FEET MILES ❑ S ❑ W❑ N 4TH ST 0 8 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2067103749 30 6❑ LAST NAME REZA REZA FIRSTNAME SAMUEL MIDDLE G 1 1 2 31 INITIAL STREET ❑, 4811 S 124TH ST CITY SEATTLE ST WA ZIP', 98178 z NEW ADDRESS ❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 7 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ DRIVER'S STATE SEX'M D.o.6. 01 - 19 - 2005 32 LICENSE# MMD)3YY 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 1 HELMETU E 2 CLASSY 6 [NATURE OF IJURIES UNKNOWNN NCOMPLAINT z❑ ❑LICENSE CC17682 sTArI WWAvIN# JH4DC54875S018298 3 10❑ PI ATE# 5 ----� TRAILER STATE PLAT Eft STATE 11 3 PLATE# PLATE# FROM TO TRLR. A'RLR 1 7 33 12❑ VIN#j VIN# FROM ❑34 13� VEH.YEAR2OOS MAKE ACUR MODEL RSX STYLE CP VEHICLE TOWED NOOpLSABLIN T� I� RSTOWING YEs❑ No� VEHICLE DAMAGE IILLJJII REGISTERED OWNER INFO .0 ARIAS REZA 4811 S 124TH ST SEATTLE WA 98178 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 3 4 14 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP VEHCLE CHARGE 10 BOTTOM 5 36 LEGALLY YES❑NO❑ CITATION# 3AO141412,3AO141412 NO VALID OPER LICENSE WITH 15❑ STANDING 8 6 MOTOR PEDAL-:. PROPERTY [ZI DAM THR OLD MET PHONE UN�T 02 ❑ ❑ PEDESTRIAN ❑ YES No 1/ D:4254307500 VEHICLE CYCLE '. OWNER 16❑ LAST NAME CITY OF FIRST NAME RENTON MIDDLE INITIAL 17❑ NEW STREETREs7 1055 S GRADY WAY CITY RENTON ST WA ZIP 98057 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs❑NOF YES ❑NO❑ 19 LLIRIVERSTICENS # STATE SEX V MMDDYY 39 WELMET INJURY NATURE OF INJURIES 4O 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ LICENSE TArE vIN1 41 1 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO 1 9TOP 5 VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s e =ORAJEWSKI (PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12399 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED56516 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4845 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RODRIGUEZ-SIERRA JORGE L (/AST FIRST, ADDRESS&PHONE# 16621 BENSON RD S LOWR RENTON WA 98055 4254444328 SEX M MMDOYyry 12 - O6 - 2003 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELIVIET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX MMDDYYYY PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. 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. RAYMOND GORAJEWSK/ 04-30-23 12:04 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 5/2/2023 2:55:18 PM BADGE OR ID# 12399 ORI# WA0171300 TIME POLICE DISPATCHED 10:53 PM TIME POLICE ARRIVED',10:54 PM PART Ei PAGE IT]OF 4� REPORT NO. ED56516 CASE# 23-4845 OF COLLISION 04/29/23 22:51 OF CbLLI510N NARRATIVE ASSIGNMENT/ARRIVAL On 04/29/2023 at approximately 2253 hours, I was dispatched to a sound of a vehicle collision near the intersection of Park Avenue N and N 4th Street in the city of Renton, King County, Washington. I arrived at approximately 2254 hours and found a collision in front of 433 Park Avenue N. UNIT 1: ACURA RSX I observed a silver Acura RSX (WA/ CCL7682, Unit 1) stopped on all four wheels facing west on the west sidewalk of Park Avenue N in front of 433 Park Avenue N. Unit 1's driver side was engaged with a City of Renton streetlight pole, which was not damaged in the collision. Unit 1 had heavy damage to the driver door from striking the pole. DRIVER: REZA REZA, SAMUEL G. I located Samuel G. Reza Reza (DOB: 01/19/2005) laying on the grass in front of 433 Park Avenue N surrounded by a large crowd who identified Samuel as the driver. I identified Samuel by a foreign national identification card and his admission. Samuel did not have a Washington Driver License or insurance information. Samuel was not speaking much, presumably due to pain from the collision. The Renton Fire Authority responded and transported Samuel to Valley Medical Center. Samuel was conscious and did not have any visible injury. WITNESS: RODRIGUEZ-SIERRA, JORGE L. I located Jorge L. Rodriguez-Sierra (DOB: 12/06/2003) standing near Unit 1. Jorge said he was a witness to the collision. The following is a summary of our conversation: Jorge was driving south on Park Avenue N toward N 4th Street behind Unit 1. Unit 1 was "doing the speed limit" and turned right to enter the driveway for 433 Park Avenue N. Unit 1 lost control and the driver side collided with a streetlight pole. This concluded my conversation with Jorge. PHOTOGRAPHS I took photographs of the collision with my department issued cell phone and uploaded them to Axon's Evidence.com. IMPOUND Samuel was not the registered owner and was not able to sign for the vehicle tow paperwork due to his medical condition. I impounded the vehicle, which was blocking the sidewalk, because Samuel was incapacitated due to his medical condition. CITATION I authored Samuel a citation for operating a motor vehicle without a valid operator license and operating a motor vehicle without insurance (Citation #3A0141412). DISPOSITION This concluded my involvement in this case. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer R. Gorajewski, #12399, on 04/30/2023 at 0000 hours in Renton, Washington. PAGE 3 OF 4 REPORT NO. ED56516 CASE# 23-4845 DATE AND TIME 04/29/23 22:51 OF COLLISION N " 433 Park Ave N Not to Seale Park Ave N PAGE 4 OF 4