HomeMy WebLinkAbout23-6400 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6400 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 06 - 1-- 2023 1643 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE SUNSET BLVD BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES❑ 200 00 FEET e S ❑ W e NE 12TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252085400 0 11
30
6❑ LAST NAME GABR/ELSON FIRSTNAME KAROL MIDDLE A 1 2 31
INITIAL
STREET ❑ 2001 NE 20TH ST CITY RENTON ST WA 21p 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 1- 05 - 1955 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ pj ATE 14 DP56043 STATE WA u N# 1 GHDT13SX22379893
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 2002 OLDS BRAVAD UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 2022-58.80.46 3 4
IN EFFECT &POLICY# 9TOP
VEHae CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2065786170
16 a
LAST NAME SANTIAGO GARCIA FIRST NAME JOSE MIDDLE
INITIAL
17❑ STREET NEW ADOREs7 21118 12TH PL S CITY DES MOINES ST' WA ZIP 98198 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t t- l NO❑
19 D IVER #
❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLATE# BOX6756 TATE WA VIN1i 1GTGG29U441138040 41
1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
V GI
VEH D
YEAR 200Q MAKE GMC MODEL SAVANNA STYLE VN AMAGE TOWED✓ NOO BLIN TOWED B ov 44
YES
HGENEMEYERS YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO NATIONAL GENRAL 2017112313IN STOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N`L J
' a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED68637
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6400
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FINNICUM KAREN I
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1302 ABERDEEN AVE NE RENTON WA 98056 4252280364 SEXi F MMDOYyry 02 - 20 - 1951
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER L�WITNESS❑ UNIT# 1 POS, 3 AIRBAG 2 RESTR, 4 EJECT USE 1 2 CLASS 17 LEGKNEE PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D 0.8
SEX I MMDDYVYV
PASSENGER ❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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.
BRYAN GROZAV 06-05-23 08:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 6/9/2023 2:44:06 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 4:45 PM TIME POLICE ARRIVED',4:46 PM
PART I PAGE IT]OF 4�
REPORT NO. ED68637 CASE# 23-6400 OF COLLISION
06/05/23 16:43
OF CbLLI510N
NARRATIVE
CASE 23-6400
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 Monday June 5th, 2023, at approximately 16:45, 1 responded to a 911 call regarding a two-vehicle
collision in the 3100 block of Ne Sunset Blvd within the City limits of Renton, King County,
Washington.
*** CALL REMARKS: 2 VEH MVA - RP ASKING FOR AID FOR HERSELF AND HER SISTER -
BOTH CONS , ARM AND LEG PAIN. 2 ADULT FEM PTS IN BLU OLDS , **3RD PT ADULT
MALE,CONS, LINK TYPE INJ - BLKING SB.
-UNIT ONE: DARK BLUE 2002 OLDSMOBILE BRAVADA WASHINGTON LICENSE: DP56043
-UNIT ONE DRIVER: KAROL A. GABRIELSON (DOB: 11.05.1955)
-UNIT TWO: WHITE 2004 GMC SAVANA WASHINGTON LICENSE: BQX6756
-UNIT TWO DRIVER: JOSE SANTIAGO GARCIA (DOB: 2.20.1968)
1 arrived on scene and contacted the involved parties and checked for injuries, Karol requested aid for
herself and sister Karen I. Finnicum (DOB:2.20.1951). Karen was seated in the front passenger seat
at the time of the collision. Renton Fire arrived shortly after and triaged all involved parties. Karol and
Karen were later transported to the hospital for further treatment.
Karen reported the following; she was waiting to take a left turn into the shopping plaza and while
waiting, traffic in the left lane stopped so she could complete the turn. Unit two was traveling in the
right lane and did not stop and crashed into her as she turned into the plaza parking lot.
Jose was traveling west bound on Ne Sunset Blvd when unit one turned in front of him, crashing into
the vehicle. Jose did not report any injuries and was the sole occupant in the vehicle at the time of the
collision.
Unit one was drivable and moved to the shopping plaza parking lot while unit two needed to be towed
since it had sever front end damage and was not drivable.
All involved vehicles were provided 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 6.05.2023 at 20:08 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED68637 CASE# ' 23-6400 DATE AND TIME 06/05/23 16:43
OF COLLISION
Z;
NOT TO SCALE
3100 BLOCK NE SUNSET BLVD
PAGE 4 OF 4