HomeMy WebLinkAbout23-8383 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8383 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# ❑
cowsloN 07 - 1-- 2023 0405 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e✓ 16400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET MILES e S B W e S 26TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065325066 30
6 LAST NAME ARGEL NAVA FIRSTNAME JOHN MIDDLE B 1 1 2 31
INITIAL
STREET ❑, 3020 S 144TH ST CITY SEATAC ST WA 2jp, 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 4 RESTR 4 EJECT 1 I I [NATURE OF INJURIES
H U EET 2 1 INJURY CLASS ju PAIN/N LEFT ARM z❑
3
LICENSE CGG8374 sTArI WAvIN# JHMGD374775017808
10❑ PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12❑ vIN#' VIN#
2007 HOND FIT CQ ❑ FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
13 $ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO STATE FARM 535.7809-C26.47 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,DIING
UNIT MOTOVEHIR
❑ CYCLE ❑ PEDESTRIAN ❑ OWN ARTY [:]EA.
NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It 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❑ TArE 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
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VE."LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s � e
7SI
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
12225 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84869
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8383
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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'
RPD CASE#: 23-8383
On 07/22/2023 at approximately 0410 hours, I was dispatched to S 26th ST and Benson RD S, in the
City of Renton, King County, Washington, for an injury accident.
Upon arrival I observed a Blue Honda Fit, bearing WA license #CGG8374, blocking the northbound
lane in the 16400 block of Benson RD S. the driver side airbags had deployed and there was damage
to the left tires of the vehicle.
I identified the driver via his WAID and his Venezuelan drivers license as John Bayron Argel Nava
(DOB 11/27/1997). Using language line for Spanish, Nava told me he was driving northbound in the
16400 block of Benson RD S getting ready to enter a curve in the road, when an unknown make or
model vehicle cut him off. Nava stated he swerved to avoid hitting the vehicle and he hit the small
barrier dividing the roadway causing damage to his vehicle.
Nava stated he had minor pain in his left arm, and he was seen by Renton Fire and cleared. Gene
Meyers Towing was called to the scene and towed the vehicle from the location. I provided Nava with
my business card with the case number on it and cleared the scene.
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 E. Sims on 07/22/2023 at 0456 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.SIMS 07-22-23 05:15 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 7/31/2023 8:24:04 PM
BADGE OR ID# 12225 ORI#' WA0171300 TIME POLICE DISPATCHED 4:10 AM TIME POLICE ARRIVED 4:13 AM
PART I PAGE IT]OF
REPORT NO. ED84869 CASE# 23-8383 DATE AND TIME 07/22/23 04:05
OF COLLISION
NOT TO SCALE
___ _�tJNIT'1
Small yellow barrier---J
Benson RC3<
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