HomeMy WebLinkAbout24-00211 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-00211 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' FENCE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 01 - 1-- 2024 0246 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE PETROVITSKY BLOCK NO. e✓ 12627
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ MILES�,❑ FEET e S ❑ W e 126THAVESE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063011279 30
6 LAST NAME PENA MENJIVAR FIRST NAME HUGO MIDDLE A 1 2 31
INITIAL
STREET ❑, 29540 32ND PL S CITY AUBURN ST WA 2jp, 98001 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 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10� P1 ATE 14 C33838Y STATE WA v N# 1 N6AD07W75C442473
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12❑ VIN#' VIN#.
Rom 34
13� VEH.YEAR2OOS MAKE NISS MODEL FRONTI STYLE TR VEHICLE TOWEDNOOpLSABLIN T� I� RSTOWING vOs❑ENo /
DAMAGE IILLJJII
REGISTERED OWNER INFO HUGO PENA MENJIVAR 2154132ND PL S AUBURN WA 98001 D:2063011279 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE Z INSURANCE CO NATIONAL GENERAL INSURANCE 2017127610
IN EFFECT &POLICY#
C
veHICLe HARGE ❑ 36
LECALLv res❑NO❑ CITATION# BOTTOM
15❑ MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNFR ❑ YES 1/ NO D:2062270073
16❑
LAST NAME CHULAPARN FIRST NAME YANGJOM MIDDLE
INITIAL
17 STREET NEW ADDREs7 17434 128TH AVE SE CITY RENTON ST WA ZIP 98058 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 DRIVEW # STATE SEX F M .C.B. 12 _ 21 197 9 39
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PIR I I TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ 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 I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# T AGENCY
26
J RAYGOZA 12503 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE37981
COLLISION REPORT III III III III III 111
1591972 CASE# 24-00211
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#: 24-00211
On 01/07/2024 at approximately 0248 hours, I responded to 12627 SE Petrovitsky RD, in the City of
Renton, King County, Washington, for a report of a non-injury collision.
Upon arrival I noticed a vehicle identified as a gray 2005 Nissan Frontier WA/LIC C33838Y
VIN#1 N6AD07W75C442473 on its side in between the sidewalk and an embankment. I spoke to the
driver of the vehicle identified by his WADOL as Pena Menjivar, Hugo Alberto DOB (02/16/2006) who
was standing on the sidewalk near his vehicle, and he stated that following: Hugo was driving
southbound on 128th Ave SE and was making a right turn at the intersection of 128th Ave SE and SE
Petrovitsky RD when he hydroplaned and lost control of his vehicle. Hugo stated that he tried to gain
control of his vehicle but spun out in the process and collided with a fence nearby. Hugo was then
helped by nearby residents who said they didn't see anything but only heard a vehicle crash. Hugo
stated that he was not injured but was evaluated by fire as a precaution and was cleared medically.
Hugo provided me with his driver's license, registration and insurance.
I spoke with the resident and homeowner of the location identified by her WADOL as Chulaparn,
Yangjom DOB (12/21/1979) and informed her of her fence. Yangjom said she didn't know the
approximate value of the fence and was given my business card with the case number. Banker's
Towing arrived shortly after and towed the vehicle out of the embankment. I gave Hugo my business
card with the case number and once all parties left the location, I 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 J. Raygoza on 01/07/2024 at 0430 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.
J RAYGOZA 01-07-24 04:27 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
GREGORY BILLS 12495 1 11712024 5:12:08 AM
BADGE OR ID# 12503 ORI# WA0171300 TIME POLICE DISPATCHED; 2:48 AM TIME POLICE ARRIVED 2:53 AM
PART I PAGE IT]OF 3�
REPORT NO. EE37981 CASE# ' 24-00211 DATE AND TIME 01/07/24 02:46
OF COLLISION
Unit 1,
IOU
House
Of
40
csi
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