HomeMy WebLinkAbout23-4644 (2) POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED57081 170
27
COLLISION REP FIT 1591971
CASE 23-4644 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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# ❑
cowsloN 04 - 1-- 2023 1815 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
GARDEN AVE N BLOCK NO. e✓ 1100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 1. 00 FMILES EET e S B W e N SOUTHPORT DR
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4273644898 0 11
30
6� LAST NAME PEEBLES FIRSTNAME RAISHAWN MIDDLE J 1 1 2 31
INITIAL
STREET ❑✓ 400 S 152ND ST#B9 CITY BURIEN ST WA ZIP 98148 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CFH1630 sTArI WAVIN# ZFBERF8B7H6G56546
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. TRLR 1 3 33
12 3 0 VIN#' VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 3 2017 RAM PROMA VN DAMAGE vE8 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 953552476 3 4
IN EFFECT &POLICY# STOP
❑ LEGALLY LE CHARGE 1 5 36
15 2 VE"'C NG YEs No clTAnoN# 3A0265762 IMPROPER LANE USAGE o aorrob
MOTOR PEDAL- ❑ '.PEDESTRIAN PROPERTY DAM THR PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ No OLD MET D:4255235563
16 a
LAST NAME MENDEZ SOTO FIRST NAME OMAR MIDDLE M
INITIAL
STREET
17 NEW ADDREsB❑' 1100 SUNSET BLVD NE#A306 CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK vEs I I NOF YEs t l NOF,/
19[—] D IVE
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# AZA3513 TArE WA VIN# 1GNFK13058J223346 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED By Gov H 44
VEH YEAR 2008 MAKE CHEV MODEL TAHOE STYLE (/T —FEHICLE
TOWED✓ NOO BLIN BANKERS YES N.7
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&PORGY#E CO PACIFIC STAR 5538476IN 1GQ
5
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N` :]
25 s � e
7HAL
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
Y BRUS 11663 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED57081
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4644
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DALBALCON LAUREN E
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
3421 110TH ST SE EVERETT WA 98208 4258770122 SEXi F MMDOYyry 11 - 03 - 1997
PASSENGER R WITNESSFVI UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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.
HALLEY BRUS O4-25-23 08:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 5/4/2023 11:35:21 AM
BADGE OR ID# 111663 OR]# WA0171300 TIME POLICE DISPATCHED 6:18 PM TIME POLICE ARRIVED 6:20 PM
PART I PAGE IT]OF 4�
REPORT NO. ED57081 CASE# 23-4644 OF COLLISION
04/25/23 18:15
OF CbLLI510N
NARRATIVE
Assignment:
On 4-25-23, 1 was working uniformed patrol in a marked Renton PD unit. At approximately 1818
hours, I was dispatched to investigate a traffic collision that occurred in the 1100 block of Garden Ave
N, in the City of Renton, County of King (WA).
Scene:
The 1100 block of Garden Ave N is a two-way north-south bound street with a southbound center left
turn lane and two lanes of travel in each direction. There is a barrier separating north and
southbound lanes of traffic and the center turn lane, going to the Lowe's parking lot, does not have a
traffic control device.
Arriva I:
Upon arrival, I saw a white Ram Promaster (WALic#CFH1630, Unit#1) with front driver's side
damage. There was also a black Chevrolet Tahoe (WALic#AZA3513, Unit#2) with front passenger
side damage. Both drivers were with their respective vehicles.
Statement of Raishawn Peebles:
Peebles (identified by WADL) was driving Unit#1 southbound in the outside southbound lane in the
1100 block of Garden Ave N. Peebles change lanes, to the left, inner most southbound lane. Unit#1
collided with the front passenger side of Unit#2. Peebles stated he had his left turn signal on when
he changed lanes.
Unit#1's front driver side airbag had deployed. Fire arrived on scene and assessed Peebles for
injuries. Peebles stated he was not injured, and further medical attention was not necessary.
Peebles stated there was no damage to Unit#1 prior to this incident.
Statement of Omar Mendez Soto:
Mendez Soto (identified by WADL) was going straight ahead, southbound, in the inner most
southbound and center left turn lane in the 1100 block of Garden Ave N. Mendez Soto stated he was
preparing to turn left into the Lowe's parking lot when Unit#1 drove into his lane and collided with the
side of Unit#2.
Mendez Soto stated he was not injured and there were no defects to Unit#2 prior to this incident.
Mendez Soto stated Unit#1 had their left turn signal on but they were so close to his vehicle by this
time that he could not avoid a collision.
Statement of Lauren Dalbalcon:
I contacted a witness who identified herself by WADL as Lauren Dalbalcon. Dalbalcon stated Unit#1
was in the outer southbound lane and quickly changed lanes to the left, without observing that Unit#2
was in that lane. Dalbalcon stated Unit#1 caused the collision.
Damage:
The damage on both vehicles on scene matched both statements.
Tow:
Two Bankers Company tows were requested on scene, per the owners of Unit#1 and Unit#2.
Summary:
Based on statements provided and the supporting physical evidence, I determined Peebles caused
the collision when he changed lanes (moved Unit#1 from his lane to another) without ensuring that it
was safe to do so. I issued Peebles RPD Citation #3A0265762 for Improper Lane Usage.
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 H.Brus/11663 at 2022 hours on 4-25-23, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. ED57081 CASE# ' 23-4644 DATE AND TIME 04/25/23 18:15
OF COLLISION
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