HomeMy WebLinkAbout23-2496 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED38549 170
27
COLLISION REP FIT 1591971
CASE 23-2496 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 02 - 1-- 2023 1859 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4033
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES❑ 50 00 FEET e S ❑ W e UNION AVE NE
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255246335 0 11
30
6� LAST NAME PROCTOR FIRSTNAME SHELBY MIDDLE N 1 1 2 31
INITIAL
STREET 01 139 UNION AVE NE#3 CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE CCR1381 sTArI WAurN# JN8AS5MT8DW030967
10❑ PI ATE 14
0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2013 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 3 34
13 4 NISS ROGUE UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 4595913569 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE- ❑ ❑ OWNER [:]EA.
YEs No ,/ D:4255246335
16 a
LAST NAME KOTNIUKH FIRST NAME VALENTYN MIDDLE
INITIAL
17❑ NEW STREETR 7' 13028 SE 95TH WAY CITY NEWCASTLE ST WA ZIP 98056 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK yEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.O.B. 03 _ 21 1999 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CFZ5979 TArE 41
WA VIN# 3FAHP07Z78R172627 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
GI
VEH YEAR 2008 MAKE FORD MODEL FUSIONS STYLE $D DEHICLE AMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38549
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2496
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'
On 02/28/2023 at 1859 hours dispatch requested that I respond to a collision that occurred at
Emerald Haze, 4033 NE Sunset Blvd. Upon my arrival I spoke with the driver of unit 1, a 2013 Nissan
Rogue bearing Washington plates CCR1381. The driver, identified as Shelby N. Proctor, explained
she was exiting the parking lot of Emerald Haze when the collision occurred. Shelby crossed all three
eastbound lanes to place her vehicle in the left turn lane from Sunset Blvd NE to Union Ave NE. As
she proceeded through, unit 2 did not slow down, striking her vehicle and displacing her left tire. The
vehicle became undriveable, so it needed to be removed by Gene Meyers Towing.
I then spoke with the driver of unit 2, a 2008 Ford Fusion bearing Washington plates CFZ5979. The
driver, identified as Valentyn Kotniukh, explained he was driving eastbound on NE Sunset Blvd when
the collision occurred. As Valentyn placed his vehicle in the left turn lane, unit 1 randomly entered his
lane, which did not give him enough time to bring his vehicle to a complete stop, causing him to hit
unit 1's driver side tire.
Unit 2 was drivable and sustained minor damages.
An exchange of information was given to both drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-28-23 08:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 31112023 11:39:15 AM
BADGE OR ID# 12007 ORI#' WA0171300 TIME POLICE DISPATCHED! 7:09 Pry TIME POLICE ARRIVED 7:02 Pry
PART I PAGE IT]OF
REPORT NO. ED38549 CASE# ' 23-2496 DATE AND TIME 02/28/23 18:59
OF COLLISION
Union Ave NE
t
NE Sunset Blvd
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