HomeMy WebLinkAbout23-5085 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED57618 170
27
COLLISION REP FIT 1591971
CASE 23-5085 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 3 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#
cawsloN 05 - 1-- 2023 1425 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a OAKESDALE AVE SW,
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2066501673 0 11
30
6� LAST NAME STOVALL FIRSTNAME BRANDON MIDDLE S 1 1 2 31
INITIAL
STREET ❑1 30819 124TH AVE SE APT D301 CITY AUBURN ST I WA 2jp, 980923367 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LRIIVER # STATE WA SEX'M I EL MI MIT Y
8❑ ' 12 — 21 — 1981 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit BCW9984 sTArI WA urN#' 1FADP3F22FL326791
TRAILER STATE TRAILERSTATE FROM ro 11 0 0 PLATE# PLATE#
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2015 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 FORD FOCUS 4D DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CHRISTIEHE .12902 SE312TH STB403 AUBURN WA 98092 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
VE— CHARGE 10 BOTTOM 36
LEGALLY YEs❑NO CITATION# 3AO095085,3AO095085 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:5036913118
16 a
LAST NAME FALEALILI FIRST NAME MARCUS MIDDLE I S
INITIAL
17 STREET I S❑' 2101 SW SUNSET BLVD APT B101 CITY' RENTON ST WA ZIP 980576120 4❑ 37
NEW ADDRES
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 STATEWASEXM .C.. _ 39
LICENSE# M .
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# T602697 TArE 41
OR vIN1 1FVACWFC6JHJR0829 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 201E MAKE FRHT MODEL M2100 STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO INC CARUSO PRODUCE 2100 SE 4TH AVE CANBY OR 97013 D:5036913118 N:5037305752 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
INAEFFIECTTY NSURANCE� &POINSULICY#E CO 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26
ALEKSANDR IGNATOV 12619
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED57618
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5085
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'
Unit one was traveling westbound on SW Grady WAY, in lane 2 of 3, approaching Oakesdale Ave
SW. Unit two was traveling westbound on SW Grady Way, in lane 1 of 3 (left turn lane), approaching
Oakesdale Ave SW. Unit one made an unsafe lane change into lane 1 of 3 from lane 2 of 3 and
struck unit two who was all ready in control of lane 1 of 3.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ALEKSANDR IGNATOV 05-05-23 03:54 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.SKELTON 9139 5/6/2023 4:10:20 AM
BADGE OR ID# 12619 ORI# WA0171300 TIME POLICE DISPATCHED; 2:28 Pry] TIME POLICE ARRIVED',2:37 PM
PART I PAGE IT]OF 3�
REPORT NO. ED57618 CASE# ' 23-5085 DATE AND TIME 05/05/23 14:25
OF COLLISION
OA,KESDALE AVE SW
2
� G7
i
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