HomeMy WebLinkAbout23-7801 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7801 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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 CITY# ❑
cawsloN 07 - 08 - 2023 1806 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE PETROVITSKY RD BLOCK NO. e✓ 12300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FEET MILES e S ❑ W e 118THAVESE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066198451 0 11
30
6� LAST NAME DOMINGO FIRSTNAME MANUEL MIDDLE A 1 2 31
INITIAL
STREET ❑ 12325 SE PETROVITSKY RD CITy RENTON ST WA ZIP 98058 z
'NEWADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES �/NO INTERLOCKYEs Z/NO YES 1/ NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 12 1- 20 - 1972 2 32
JURY [NATURE OF
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 9 EJECT 1 HELMETU SE CLASS 0 NECK,BACK,,LEG PAIN z❑
3
10 9❑ P1 AT 14 CHt 1233 STATE WA VIN# 1 D4GP25R156121177
IT STATE TRAILER STATE
11 0 0 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 5 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 7 34
13 4 2005 DODG CARAVA DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO MANUEL MARTIN 12325 SE PETROVITSKY RD RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# _
VEHlcl.e CHARGE 5 ❑ 36
LEGALLY YES❑NO❑ CITATION# 3AO130086,3AO130086 OPER VEH W/OUT IGNITION BOTTOM
15❑ STANDING
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4253010384
16 a
LAST NAME WEBB FIRST NAME CALISTA MIDDLE M
INITIAL
17❑ STREET ❑', 24627 185TH PL SE CITY COVINGTON ST WA ZIP 98042 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES❑No� INTERLOCK veS No� YES NDF
19 LDIIVEW # STATE WA ]SEX IF MMDDW 04 15 _ 1999 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT ''1 USE CLASS ❑
21❑ LICENSE I BZP5853 TATe WA VIN# KNDCD3LD9J5213597
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE KIA MODEL NIRO STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO BONITA WEBB 24627185THPL SE COVINGTONWA 98042 D:4253010384 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY INSURANCE INSU&PORGY#E CO CALIFORNIA CASUALTY GENERAL 1026236734 STOP 5
IN EFFECT
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
LACY SMITH 12613 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84856
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7801
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RODEBAUGH ANDRIA E
(LAST FIRST,
ADDRESS&PHONE#
17425 119TH LN SE RENTON WA 98058 2533506101 SEXi F MMDOYyry 01 - 12 - 1999
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑j UNIT# 2 POS ! 8 AIRBAG 6 RESTR. 9 EJECT I I USE CLASS 17 aaw
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
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.
LACY SMITH 07-13-23 12:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:25:42 PM
BADGE OR ID# 12613 ORI#' WA0171300 TIME POLICE DISPATCHED; 6:06 PM TIME POLICE ARRIVED',6:11 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED84856 CASE# 23-7801 OF COLLISION
07/08/23 18:06
OF CbLLI510N
NARRATIVE
The following report is a summary of the events that occurred while my AXON body-worn camera
was on and activated.
On 07/08/2023, 1 was assigned to District 13 as the, 3R13. At approximately 1807 hours I was
dispatched to a two-vehicle collision at approximately the 23000 block of SE PETROVITSKY RD.
This is located in the city of Renton, the county of King, and the state of Washington.
Unit 1- CHL1233
Driver of unit 1- MANUEL DOMINGO
Unit 2- BZP5853
Driver of unit 2- CALISTA WEBB
I arrived on scene and was unable to speak to DOMINGO due to the Fire department attempting to
extricate him from the front driver seat of vehicle CHL1233. I was able to positively identify MANUEL
DOMINGO, by his Washington State Identification card that he had provided to another Officer on
scene.
I contacted the driver of unit 2 and positively identified her as, CALISTA WEBB, by her Washington
State driver's license. WEBB stated she was driving Eastbound on SE Petrovistky RD when unit 1
turned out of the driveway on the south side of the road to go Westbound on SE Petrovistky RD. Unit
2 attempted to avoid the accident however she was unable to and unit one collided with the front
passenger side of unit 2.
Unit 1 had damage on the front driver's side. Unit two had damage on the front passenger side.
Based on the statements made and the evidence on scene it appears unit one did not yield the right
of way to oncoming traffic and turned on the SE Petrovisty RD.
Both vehicles were towed from the scene by Gene Meyers.
A DOL check of Domingo revealed he does not of a valid driver's license (Suspended/Revoked 3rd
Degree, with driver restriction of the requirement of an ignition Interlock device system of the vehicle.
The vehicle Domingo was driving CHL1233 was not equipped with an ignition interlock device.
Domingo was transported to the hospital for his injuries.
Domingo was cited for R.C.W 46.20.740 for violating interlock requirements and RCW 46.20.342 for
driving with a suspended and revoked license. 3A0130086, 3AO130086
PAGE 3 OF 4
REPORT NO. ED84856 CASE# ' 23-7801 DATE AND TIME 07/08/23 18:06
OF COLLISION
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