HomeMy WebLinkAbout23-1349 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-1349 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
cawsloN 02 - 01 - 2023 0826 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES N EET e S B E e SE 154TH PL
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069159948 0 7 30
6� LAST NAME VOZNYUK FIRSTNAME PETER MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 12678 SE 307TH ST CITY AUBURN ST WA 2jp, 980923198 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 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ pICENSE1l ATE 14 SH18810 STATE WA u N# WD3PE8CC7C5666942
TRAILER STATE TRAILED STATE
11 4 0 PLATE# PLATE# FROM ro
TRLR. TRLR. 5 1 33
12 4 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34
13 4 2012 MERZ SPRINT VN DAMAGE YES YES[:] No
REGISTERED OWNER INFO PETER VOZNYUK 12678 SE 307TH ST AUBURN WA 98092 D:2069159948 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE SAFECO H2366215
IN EFFECT &POLICY# 9TOP
EGA LE CHARGE 36
L EH'C YES❑NO❑ CITATION# 10 BOTTOM
15❑ 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062281828
16 a
LAST NAME MA FIRST NAME TEA MIDDLE K
INITIAL
17❑ NEW STREETR 15447 S
7 E 21 ST PL CITY' BELLEVUE ST WA ZIP 980076301 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C... 08 _ 10 _ 1957 39
LICENSE# MMDCDY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AYM1240 TATE WA VIN# 41
STDZA23C86S456811 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2006 MAKE TOYT MODEL SIENNA STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO TEA MA 15447 SE 21STPL BELLEVUE WA 98007 D:2062281828 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 962296060IN 1 GD
VE""LE CITATION# CHARGELEGAL25
LY YES N�
❑ s e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED30440
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1349
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
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 02-01-23 10:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 2/1/2023 4:58:10 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED: 8:38 AM TIME POLICE ARRIVED',8:48 AM
PART I PAGE IT]OF
TIME
REPORT NO. ED30440 CASE# 23-1349 OF COLLISIONO2/01/23 08:26
NARRATIVE
23-1349
On 02/01/2023 at approximately 0838 hours, I was dispatched to a non-injury and blocking vehicle
collision in the 15300 block of 140th Way SE, within the City Limits of Renton, County of King, State
of Washington.
Upon arrival, I confirmed there were no complaints of injury requiring immediate medical response.
The driver of Unit#3 did complaint of minor chest pain from her seatbelt but stated she would follow-
up with her doctor at a later date. While on scene, I collected the each of the involved driver's
information and their independent recollection of the events leading up to the collision.
The driver of Unit#1 said he was the sole occupant of his vehicle and was traveling northbound in the
15300 block of 140th Way SE in lane 1 of 2 JNO the intersection of SE 154th Pl. The driver of Unit#1
stated he was traveling directly behind Unit#2 when he noticed Unit#2 immediate come to a stop
due to queued traffic ahead. Unit#1 stated that he subsequently collided with the rear of Unit#2
causing minor damage to the front of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and was traveling northbound in the
15300 block of 140th Way SE in lane 1 of 2 JNO the intersection of SE 154th PI. The driver of Unit#2
stated he had come to a stop for traffic that had queued in front of him. While Unit#2 was stopped,
Unit#1 collided with the rear of Unit#2 causing minor damage to the rear bumper of Unit#2.
The driver of Unit#3 said she was the sole occupant of her vehicle and was also traveling northbound
in the 15300 block of 140th Way SE in lane 1 of 2 JNO the intersection of SE 154th PI. The driver of
Unit#3 stated she was traveling directly behind Unit#1 when she noticed Unit#1 immediate come to
an abrupt stop. The driver of Unit#3 stated she was unable to avoid the collision and subsequently
collided with the rear of Unit#1 causing significant damage to the front of Unit#3 and additional
damage caused to the rear of Unit#2.
Based on the above statements, I determined that the Driver of Unit#1 (Voznyuk) was the
predominant factor for the cause of collision due to not paying attention to traffic stopped in front of
him causing a collision.
All of the involved vehicles were able to be driven away without further incident. An exchange of
information was provided to all 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 10:59 AM 2/1/2023 Renton, King County, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED30440
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-1349
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70T !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME 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:2532178303
0 1 29
LAST NAME TOLONEN FIRST NAME KELLY MIDDLE' E
INITIAL
STREET 30
NEW AnnRFSP 11400 SE 223RD ST CITY KENT ST WA ZIP 980312635
6 ❑ 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 F MMDDYYv 08 - 28 - 1992
7
HELMET :INJURY' NATURE OF INJURIES
ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 6 C/O CHEST PAIN FROM SEA TBELT
8 ❑ 1 32
LICENSE BGG3209 TAr Wq VIN# 5J6RE4H51AL030618
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 4 O VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1I' P FROM TO
2010 HOND CR-V SV DAMAGE YES NO YES NO
33
REGISTERED OWNER INFOKELLY TOLONEN 17512149TH AVE SE UNIT FI2 RENTON WA 98058 D:2532178303 $ 1
12 SHADE IN DAMAGED AREA
7 j 4 FROM TO
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 937574972 q"i"Olx
IN EFFECT &POLICY#
VEHICLE 34
13 ❑ Lecnuv YES[:] NO❑ CITATION CHARGE 10 BOTTUM
STANDING } 8 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME INITIAL
MIDDLE ❑ 36
STREET
16 NEW AnnRFs� CITY ST ZIP
CDL IGNITION REdUiRED IGNITION 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 TAT 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 AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LECALLv
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 02-01-23 10:59 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26F7 OI BADGE 11498 O#I WA0171300 JOHNSON 2/1/2023 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. ED30440 CASE# 23-1349 DATE AND TIME 02/01/23 08:26
OF COLLISION
Uniitt#2
*Diagram not to scale0
Unit#1
Unit#3
=Direction of Travel,prior to impact
PAGE 5 OF 5