HomeMy WebLinkAbout23-7771 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-7771 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� TOTAL#OF OBJECT 1 �2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 07 - 08 - 2023 0152 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK SEMAYVALLEYRD MILEPOST
e✓ 14408
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6� LAST NAME REY-SERVANDO FIRSTNAME CRUZ MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 5610 41ST DR SE CITY EVERETT ST WA 2Ip, 98201 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO Z/ INTERLOCKYEs NO�/ YEs No�/
$ DRIVERS
# STAfE SEX'M MDMDD� 02 - 08 - 2001 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES 2❑
USE CLASS NO VISIBLE INJURIES/TRANSPORTED
3
10❑ Pl QTNFS# CGE0772 STATE WA VIN#' 2T1BU4EE2AC400366
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FRom ro
TRLR. TRLR 3 7 33
12❑ VIN#' VIN#i
Rom 34
13❑ VEH.YEAR 2OIO MAKE TOYT MODEL COROL STYLE 4C VEHICLE TOWED No pLSSBLIN TQ yEq.BLRs YES❑ENO
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO CRUZ REY-SERVAND0161041ST DR SE EVERETT WA 98201 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY#
LEGA LE CHARGE 5 ❑ 36
LECALLv res❑NO❑ CITATION# BOTTOM
15❑ STAIN,DIING 6
UNIT U2 VEHICCMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL- P YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24❑ 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 IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
N AAH G/RELLO 12607 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED80069
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7771
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GARCIA ANGEL
(LAST FIRST,
ADDRESS&PHONE#
5610 41ST DR SE EVERETT WA 98201 SEX M MMDOYyry -�-
PASSENGER L, WITNESS❑ UNIT# 1 POS 3 AIRBAG'6 RESTR. 4 EJECT ? 1 H US ET 2 `CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
NOAH GIRELLO 07-09-23 07:49 PM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 711612023 2:32:59 PM
BADGE OR ID# 12607 ORI# WA0171300 TIME POLICE DISPATCHED 1:53 AM TIME POLICE ARRIVED]Y:05 AM
PART Ei PAGE IT]OF 4]
REPORT NO. ED80069 CASE# 23-7771 OF COLLISION
07/08/23 01:52
OF CbLLI510N
NARRATIVE
23-7771
At about 0153 hours on 07/08/2023 1 was dispatched to an injury accident at, 14408 SE May Valley
RD, in the city of Renton, King County, Washington. Dispatch advised me that this was a single car
roll over and the extent of the injuries were unknown.
Vehicle: Grey 2010 Toyota Corolla (LIC/CGE0772) (VIN/2T1 BU4EE2AC400366)
Driver: Cruz R Rey-Servando (DOB 02/08/2001)
Passenger: Angel Garcia (UNK DOB)
Upon my arrival 2 King County deputies and the fire department were already on scene. The fire
department already had the driver out of the vehicle and sedated due to his pain. I did not observe
any visible injuries on the driver as the fire department was working on him. The passenger was also
out of the vehicle and was alert and walking and had no complaints of pain.
The vehicle was flipped over on its roof on the north side of SE May Valley in the ditch. The vehicle
was traveling west bound but came to rest with the vehicle pointing NE in the ditch. There were no
other vehicles involved in the accident and the vehicle did not strike any other objects. The guard rail
on the south side of the road had no damage or indication that the driver may have hit it. After some
emergency vehicles cleared, I searched the roadway for tire marks and found nothing. There was
noting in the roadway that indicated how the vehicle may have flipped over.
Because the driver was already sedated upon my arrival and transported shortly thereafter, 1 was
unable to speak with the driver about what happened. In addition, the passenger told me that he was
asleep in the passenger seat at the time of the accident and had no idea what happened. There were
no witnesses to the accident and there were no cameras in the area due to it being a secluded road.
The only indication of how the accident happened is that there is a ditch on the north side of the road.
The ditch is where the vehicle ended up and its possible the vehicle went off the roadway and into the
ditch causing it to roll.
Photos were taken of the vehicle, and it was later towed/ impounded by Bankers. Bellevue fire ended
up responding to this collision and later transported the driver to Overlake hospital with suspected
non-life threatening injuries.
This concludes my involvement with 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 N. GIRELLO #12607 on 07/08/2023 at 0300 Renton, WA
PAGE 3 OF 4
REPORT NO. ED80069 CASE# 23-7771 DATE AND TIME 07/08/23 01:52
OF COLLISION
DITCH ALONGSIDE ROADWAY
SE MAY VALLEY RD
PAGE 4 OF 4