HomeMy WebLinkAbout23-1334 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-1334 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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 01 - 1-- 2023 2341 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 1600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a SUNSET BLVD N
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2065568510 0 11
30
6❑ LAST NAME LOPEZ RUIZ FIRST NAME CRISTO MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 1019 MONROE AVE NE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
❑
iNTERLOCKYEs NO 1/ INTERLOCK YES NO Z/ YEs No�/
8❑ LDRIVER # STATE WA SEX 1'M MMDDYY 08 - 26 - 2002 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 CLASS 6 [NATURE OF
LEFT LEG I PAIN E9 z❑
3
10 1❑ PI ATES14 VTG502 STATE OR VN# JN1CA21D1VM537048
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 34
13 1997 NISS MAXIMA SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO CRISTO LOPEZ RUIZ 1019 MONROE AVE NE RENTONWA98056 D:2065568510 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO <53 4
IN EFFECT &POLICV# TOPVEr�ICLE CHARGE 36
LEGALLvres❑NO CITATION# OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES NO 1/ D:2068534306
LAST NAME KHANDZHAYAN FIRST NAME SERGEI MIDDLE M
INITIAL
17 STREET❑ NEW ADDRESS❑' 12652 SE 160TH ST CITY RENTON ST WA ZIP 98058 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 LDIIVEW # STATE WA SEX M M .C.B. 12 _ 08 _ 1985 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CEK7034 TATE 41
WA VIN# 1FMEE5DP6NL637294 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GoI
VEH YEAR 2022 MAKE FORD MODEL BRONCO STYLE $P DAMAGE TOWED NOO✓ BLIN TOWED BY v HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU8 PORGY#E CO GENERAL AUTO INSURANCE 53-WA 4905288 1 9TOP 5
IN EFFECT
vE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES s a
=ORAJEWSKI
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12399 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED31203
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1334
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JACKSON AUBREYJ
(LAST FIRST,
ADDRESS&PHONE# D O.B.
11442 70TH PL S SEATTLE WA 98178 2063767529 SEX M MMDOYyry 01 - 10 - 1985
SEAT HELMET I INJURY EFTELBOW NATURE OF INJURIES
PASSENGER ZWITNESS❑ UNIT# 2 POS 8 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS +6 L KNEE PAIN
NAME
'(LAST,FIR MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX I MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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.
RAYMOND GORAJEWSK/ 02-01-23 12:53 AM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 2/4/2023 4:19:23 PM
BADGE OR ID# ! 1Y399 OR]# WA0171300 TIME POLICE DISPATCHED', 11:43 PM TIME POLICE ARRIVED',11:47 PM
PART I PAGE IT]OF 5�
TIME
REPORT NO. ED31203 CASE# 23-1334 OF COLLISION01/31/23 23:41
NARRATIVE
ASSIGNMENT/ARRIVAL
On 01/31/2023 at approximately 2343 hours, I was dispatched to a collision at the intersection of
Bronson Way N and Sunset Blvd N in the city of Renton, King County, Washington.
I arrived at approximately 2347 hours.
UNIT 1: NISSAN MAXIMA
Upon arrival I observed a tan Nissan Maxima (Oregon VIN JNlCA21D1VM537048, Unit 1) parked in
a private drive on the north side of Bronson Way N west of Sunset Boulevard N. Unit 1 was displaying
Washington license plates BUC8616, which were not registered to the vehicle. The driver later
admitted he affixed those license plates from another vehicle he owned to avoid registration fees. The
license plates were later removed.
Unit 1 had moderate front end damage.
UNIT 2: FORD BRONCO
I observed a white Ford Bronco (WA/ CEK7034, Unit 2) stopped in the number one (closest to curb)
westbound lane of Bronson Way N west of Sunset Boulevard N. Unit 2 had minor damage to the front
driver door.
DRIVER 1: LOPEZ RUIZ, CRISTO A.
I contacted Cristo A. Lopez Ruiz (DOB: 08/26/2002) in the driver seat of Unit 1. 1 established Lopez
Ruiz as the driver of Unit 1 by his admission. 1 identified Lopez Ruiz by his valid Washington Driver
License.
Lopez Ruiz complained of left leg pain. Lopez Ruiz was evaluated on scene by the Renton Fire
Authority and released.
DRIVER 2: KHANDZHAYAN, SERGEI M.
I contacted Sergei M. Khandzhayan (DOB: 12/08/1985) standing near Unit 1. 1 established Sergei as
the driver of Unit 2 by his admission. I identified Sergei by his valid Washington Driver License.
Sergei was not injured from the collision.
PASSENGER
I contacted Aubrey J. Jackson (DOB: 01/10/1985) standing near Sergei. I established Jackson as the
front right passenger of Unit 2 by his admission. I identified Jackson by his valid Washington Driver
License.
Jackson complained of left elbow and left knee pain from the collision. Jackson refused treatment by
the Renton Fire Authority.
STATEMENT: DRIVER 1
1 spoke with Lopez Ruiz, Driver 1, about the collision. The following is a summary of our conversation:
Lopez Ruiz drove Unit 2 east on Bronson Way N toward Sunset Boulevard N. Lopez Ruiz intended to
turn Unit 2 left (north) onto Sunset Boulevard N. Lopez Ruiz entered the intersection on a yellow left
turn signal.
Lopez Ruiz saw Unit 2 driving west in the intersection from Maple Valley Highway. Unit 1's front end
collided with Unit 2's front driver door as Lopez Ruiz turned Unit 1 left (north) in the intersection.
Lopez Ruiz believed he did not enter the intersection on a red left turn signal.
This concluded my conversation with Lopez Ruiz.
STATEMENT: DRIVER 2
Officer H. Brus spoke with Sergei, Driver 2. Officer Brus told me the following about their
conversation:
Sergei drove Unit 2 west on Maple Valley Highway toward Sunset Boulevard N. Sergei intended to
PAGE 3 OF 5
TIME
REPORT NO. ED31203 CASE# 23-1334 OF COLLISION01/31/23 23:41
NARRATIVE
drive straight through the intersection onto Bronson Way N.
Sergei drove Unit 2 into the intersection on a solid green signal. Unit 1, which was driving east from
Bronson Way N, collided with Unit 2 in the intersection. Unit 1's front end collided with Unit 2's front
driver door.
This concluded my conversation with Officer Brus.
PHOTOGRAPHS
I took photographs of both vehicles with my department issued cell phone and uploaded them to
Axon's Evidence.com.
CITATION
Lopez Ruiz admitted to me he did not have insurance for Unit 1. 1 issued Lopez Ruiz a citation for
driving without insurance (Citation #3A0141403).
DISPOSITION
I gave all involved parties an Exchange of Information form.
This concluded my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Officer R. Gorajewski, #12399, on 02/01/2023 at 0041 hours in Renton,
Washington.
PAGE 4 OF 5
REPORT NO. ED31203 CASE# ' 23-1334 DATE AND TIME 01/31/23 23:41
OF COLLISION
Sunset Blvd N.
t�
Not to Seale:.
c a•,.
III y ...........
Bronson lNdy N ,m
age r
ay
1-405 South On:Ramp
PAGE 5 OF 5