HomeMy WebLinkAbout23-3959 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3959 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4250 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
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 04 - 1-- 2023 2113 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SOUTHPORT DR BLOCK NO. e✓ 1300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W
0 1 29
UNIT MOTOR
Z PEDAL El DAYESMAGE NHORESHOLD MET PHONE 01 0 81
30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STA fE I
SEX u MMDOBYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLJU
ASSY 0 [NATURE OF UNKNOWNNJURIEs z❑
3
10[1LICENS P1 ATE 14 C28720T sTAT WAV N# 1 GCECI4WXWZ159114
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN If UIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
2 1998 CHEV GMT-400 PK DAMAGE YES NO YES❑ NO
13 ✓
REGISTERED OWNER INFO JESUS AYALA LUGO 14411 MILITARYRD S TUKWILAWA 98168 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
❑ ❑ 2 3 4
14 LIABILITY INSURANCE INSURANCE CO UNKNOWN
IN EFFECT &POLICY# 9TOP
VE—LE 10BOTTOM 5 36
LEGALLY
res❑NO❑ CITATION# CHARGE 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D.4255951989
16 2
LAST NAME GRIGORYAN FIRST NAME EDUARD MIDDLE V
INITIAL
17 STREET I❑ 2003 REDMOND AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADOREss❑'
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 LICENSE# STATE WA SEX M M D.O.B. 05 _ 22 _ 2004 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJASS
URY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# 579YKZ TATE WA v 41
IN1 4T1BE46K99U362663 `1
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
GoI
VEH YEAR 2009 MAKE 7'Oy7' MODEL CAMRY STYLE $D —FEHICLE
TOWED NOO✓ BLIN TOWED BY vHyES NO 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DA GEbAREA
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 920381315IN 1 9TOP 5
vE""LE CITATION# CHARGE to BOTTOM
LEGALLY YES Nu
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JONATHAN SELBERT 12641 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED56943
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3959
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.
JONATHAN SELBERT 04-07-23 11:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 5/4/2023 3:09:30 AM
BADGE OR ID# 12641 OR]#' WA0171300 TIME POLICE DISPATCHED; 9:20 Pry TIME POLICE ARRIVED',9:58 PM
PART I PAGE IT]OF 6�
REPORT NO. ED56943 CASE# 23-3959 OF COLLISION
04/07/23 21:13
OF CbLLI510N
NARRATIVE
On 4/7/2023, at 2120, 1 received an assignment for an Accident Hit and Run which occurred near the
intersection of N Southport Drive and 1-405 in the City of Renton, King County, Washington State.
Call notes stated that the victim's vehicle had been struck by a white pickup which continued on
without making any attempt to exchange information and was last seen driving south on Garden
Avenue N near the intersection of N 8th Street.
My response to this call was delayed by a separate incident, RP230019511, which I was redirected
to.
When I resumed my response for the accident, I was informed that the reporting party was at their
home located at 2003 Redmond Avenue NE. I responded there and made contact with the reporting
party and driver of vehicle 2, Eduard V. Grigoryan. Eduard made the following statement:
At approximately 2110, Eduard observed vehicle 1, a white Chevrolet pickup truck, "doing burnouts"
near the Pickled Onion bar located at 1314 Union Avenue NE. Eduard showed me a brief video on
his phone of a great deal of smoke, but I could not identify the vehicle.
Eduard drove his vehicle west on Sunset Boulevard NE, stopping at a traffic light in the left turn lane
to drive onto 1-405. While stopped, at approximately 2115, his vehicle was struck by vehicle 1, which
he recognized as the vehicle he saw earlier"doing burnouts." He filmed the vehicle driving away and
obtained its license plate: C28720T. Eduard showed me this video clip and 1, too, observed the
license plate.
Eduard stated that the driver appeared to be a male in his twenties. He could provide no further
description.
I observed damage and a missing rearview mirror on the passenger side of Eduard's vehicle.
photographed this damage and uploaded the photos via Axon Capture.
I was advised that a second victim had called regarding this accident. I made contact with this victim:
Rebecca S. Hagemeister, driver of vehicle 3.
Rebecca stated that she was also stopped in the left turn lane to enter southbound 1-405 from Sunset
Boulevard NE when her vehicle was struck on the passenger side by a large white pickup truck.
Rebecca did not see the driver or get the vehicle's license plate, but she stated that the accident
occurred at approximately 2115.
Rebecca advised me that the passenger side of her vehicle was badly scratched and the rearview
mirror had been "completely destroyed."
I received a message from Officer E. Edmonds that the vehicle in my call was also involved in an
accident he responded to which occurred at 2121 near Rainier Avenue S and S 3rd Street. This
incident was documented under call number RP230019512.
A computer inquiry of license C28720T revealed it was registered to Jesus Rosario Ayala Lugo of
Tukwila, Washington. I noted that Jesus was 28 years old.
My conversations with Eduard and Rebecca were captured on my body-worn camera.
PAGE 3 OF 6
REPORT NO. ED56943 CASE# 23-3959 OF COLLISION
04/07/23 21:13
OF CbLLI510N
NARRATIVE
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 Officer J. Selbert (12641) in the City of Renton, King County, Washington
State on 4/7/2023 at 2330.
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. ED56943
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-3959
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
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:2068177086
0 8 29
LAST NAME HAGEMEISTER FIRST NAME REBECCA MIDDLE ',, S
INITIAL
STREET 30
NEW AnDRFSP 25205 108TH AVE SE K5 CITY KENT ST WA ZIP 1 98030
6 [6 1 1 2 31
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED
INTERLOCK YEs NO NTERLOCK YES❑N0� YES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv', 03 - 16 - 1977
7
ON DUTY� STATUS AIRBAG' 1 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE B►D0963 TAr WA VIN# 3CZRU6H55JG704216
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 0 0 VEH.YEAR2018 MAKE HOND MODELHRV STYLE UT I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH11' FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER J 9 33
12 � SHADE IN DAMAGED AREA
LIABILITY
INSURANCE INSURANCE CO ESURANCE 7401223 FROM To
IN EFFECT &POLICY# 5 4 TCSP S
vEwcLE 10 60T1Y)M 34
13 ❑ LEGALLY YESZ NO❑ CITATION# CHARGE
STANDING } 8 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
STRE
16 NEW
ETET".Fl CITY ST ZIP
AnnRCDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK 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 AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeGALLv
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.
JONATHAN SELBERT 04-07-23 11:43 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12641 O#I',WA0171300 APTOLLIVER 5/44/2023 PAGE F OF 6
3000-345-013(R 11118)
REPORT NO. EU56043 CASE# 23-3050 DATE AND TIME 04/07/232113