HomeMy WebLinkAbout23-9918 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9918 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 08 - 1-- 2023 1658 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 18800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 3251. 00 FEET MILES e S B W e S 190TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064878664 0 7 30
6� LAST NAME PEDROZA FIRSTNAME MARIA MIDDLE G 1 1 2 31
INITIAL
STREET ❑✓ 14032 SE 192ND ST CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATFBit BRW2120 sTArI WA urN#' 1HGCP2F41AA046156
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM TO
TRLR. A'RLR. 1 5 33
12 4 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34
13 2010 HOND ACCOR 4D DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO NESTOR PEDROZA BERNAL 14032 SE 192ND ST RENTONWA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# STOP
VE—LL CHARGE IOR TTOM 5 36
LEGALLv YES No CITATION# 3A0637841,3A0637841 FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2534863122
16 a
LAST NAME DOMINGO FIRST NAME ESTRELLA MIDDLE A
INITIAL
17 STREET NEW ADDRESS❑' 12029 SE 209TH ST CITY KENT ST WA ZIP 980312229 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt—TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
I�/]No❑
19 DRIVERS#
ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 H EET 2 NJAU SY 6 C/O NECK PAIN�TRANSP.TO VMC 40
❑ 41
21❑ ILICENSE PLATE# AOD0611 TArE WA VIN1i STDZK23C87S017204 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2007 MAKE TOy7- MODEL SIENNA STYLE VN VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24 DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO RONALD DOMINGO 12029 SE 209TH ST KENT WA 98031 D:2534863122 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 4461459-826-47AIN STOP
VEwCLE CITATION# CHARGE to BOTTOM
LEGALLY YES[Z NC[:]
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
MATTHEW NUGENT 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01704
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9918
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
PM 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'
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.
MATTHEW NUGENT 08-31-23 10:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 9/23/2023 8:47:09 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 5:02 Pry TIME POLICE ARRIVED 5:18 PM
PART I PAGE IT]OF 6�
REPORT NO. EE01704 CASE# 23-9918 OF COLLISION
08/28/23 16:58
OF CbLLI510N
NARRATIVE
23-9918
On 08/28/2023 at approximately 1702 hours, I was dispatched to a blocking vehicle collision in the
18700 block of 108th Ave SE, within the City Limits of Renton, County of King, State of Washington.
While en route, Dispatch advised that there was a 3-vehicle collision with the involved parties
blocking the center lane.
Upon arrival, I confirmed that the driver of Unit#2 was complaining of neck pain and had requested
the Renton Regional Fire Authority (RRFA) respond for evaluation. The drivers of Unit#1 and Unit#3
did not complain of injury. There, I collected the driving documents and independent recollection from
each of the involved parties leading up to the incident. The driver of Unit#2 was later treated by
RRFA and transported via TRI-MED ambulance to Valley Medical Center.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling southbound in
about the 18700 block of 108th Ave SE. The driver of Unit#1 stated she was traveling directly behind
Unit#2 and saw that Unit#2 had stopped abruptly in front of her. The driver of Unit#1 said that she
was unable to stop her vehicle in time and subsequently collided with the rear of Unit#2 causing
significant damage to the front of Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling
southbound in about the 18700 block of 108th Ave SE and had come to a stop for queued traffic. The
driver of Unit#2 stated she had come to a stop directly behind Unit#3. The driver of Unit#2 stated
that while stopped, Unit#1 collided with the rear of Unit#2 causing moderate damage to the rear of
Unit#2. Following the initial impact between Unit#1 and Unit#2, Unit#2 was subsequently pushed
into the rear of Unit#3 causing additional to the front of Unit#2.
The driver of Unit#3 said he was the sole occupant of his vehicle and was also traveling southbound
in about the 18700 block of 108th Ave SE and had come to a stop for queued traffic. The driver of
Unit#3 stated that while stopped, Unit#2 collided with the rear of Unit#3 causing moderate damage
to the rear of Unit#3.
Based on the above statements, 1 determined that the Driver of Unit#1 (Pedroza) violated RCW
46.61.145(1) as any driver of a motor vehicle shall not follow another vehicle more closely than is
reasonable and prudent, having due regard for the speed of such vehicles and the traffic upon and
the condition of the highway. Pedroza was the predominant factor for the collision due to Following
too closely causing a collision.
Pedroza also violated RCW 46.30.020(1)(a) as no person may operate a motor vehicle subject to
registration under chapter 46.16A RCW in this state unless the person is insured under a motor
vehicle liability policy with liability limits of at least the amounts provided in RCW 46.29.090, is self-
insured as provided in RCW 46.29.630, is covered by a certificate of deposit in conformance with
RCW 46.29.550, or is covered by a liability bond of at least the amounts provided in RCW 46.29.090.
Proof of financial responsibility for motor vehicle operation must be provided on the request of a law
enforcement officer in the format specified under RCW 46.30.030.
1 cited the driver of Unit#1 (Pedroza) in-person for Following Too Closely causing a collision and for
Operating a motor vehicle with insurance.
Unit#1 was able to be moved off the roadway and was later impounded by private tow due to
extensive damage. Unit#2 was impounded from the roadway due to extensive damage. Unit#3 was
able to be driven away without further incident. An exchange of information was provided to all
PAGE 3 OF 6
REPORT NO. EE01704 CASE# 23-9918 OF COLLISION
08/28/23 16:58
OF CbLLI510N
NARRATIVE
involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 8/31/2023 10:43 AM Renton, King County, WA.
PAGE 4 OF 6
SUPPLEMENTAL REPORT NO. EE01704
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-9918
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES� NO
D:2533159746
0 7 29
LAST NAME JANSUK FIRST NAME ALEX MIDDLE'.. L
INITIAL
STREET 30
NEW AnnRFrtP 14832 SE FAIRWOOD BLVD CITY RENTON ST WA ZIP 1 980588526
5 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO zERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 01 TO]
- 1989
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BKJ4673 [TAT WA VIN# JTKJF5C76GJ022381
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 4 0 VEH.YEAR MAKE MODEL STYLE VEHICLE TOME E T SABLIN TOWED BY anvi vEH1C E FROM TO
2016 TOYT SCION TIC CP DAMAGE ves No �/ YEs No
REGISTERED OWNER INFOALEXJANSUK 14832 SEFAIRWOOD SLVD RENTON WA 98058 D:2533159746 SHADE IN DAMAGED AREA J 9 33
12 z 3
FROM TO
((ABILITY INSURANCE INSURANCE CO STATE FARM 5131660-D19.47A RTOIx
IN EFFECT &POLICY# 1
EHICLE 34
13 2 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTOM
STANDING } 8 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE
❑ 35
STREET
16Fl TEETEs.�' CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YES NO YES NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAr VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 97OP - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 6OTiOM
LEGALLY
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MATTHEW NUGENT 08-31-23 10:59 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
25 ORID# 11498 O#I',WA0171300 JACOBS 912312023 PAGE F OF 6
3000-345-013(R 11118)
REPORT NO.! EE01704 CASE# ' 23-9918 DATE AND TIME 08/28/23 16:58
OF COLLISION
U
N
`7iar}ram no-t to sca&o r..
w
U np[#7 UtNt#f2 tJR#3
1;08th Ave SE
PAGE 6 OF s