HomeMy WebLinkAbout23-6185 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6185 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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 05 - 1-- 2023 1448 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 3RD ST BLOCK e✓ 970
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e PELLYAVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532503397 0 11
30
6� LAST NAME POKRYFKE FIRSTNAME MICHAEL MIDDLE R 1 2 31
INITIAL
STREET 01 11002 SE PETROVITSKY RD UNIT CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR I [NATURE OF
4 EJECT 1 H U EET 2 1 INJURY CLASS ju BROKEN RIBS INJURIES z❑
3
LICENSE CDV0106 STATE WA VIN# KNDC3DLC1N5060297
10 9❑ Pr ATE�
Fj0 IT STATE TRAILER STATE
11 0 PLATE# I PLATE# I I FROM TO
TRLR. YRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 2 2022 KIA EV6 DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO USAA 02041.17.37U 3 4
IN EFFECT &POLICY# 9TOP
VE"'C' CHARGE 1 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4258709037
16 a
LAST NAME LYTER FIRST NAME RONALD MIDDLE N
INITIAL
17 NEW STREETREs7' 23820 SE 248TH ST CITY MAPLE VALLEY ST WA ZIP 98038 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK vEs❑NOF YES
❑NOF,/
19 D IVERI #
❑ ON DUTY STATUS I
AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# BNR8439 TATE WA VIN# 41
JF2SJADC6GH424439 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED By Gov H 44
VEH YEAR 2016 MAKE S(JB�Q MODEL FORESTE STYLE 7EHICLE
TOWED✓ NOO BLIN BANKERS YES N.7
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO PEMCO CA 1591143IN STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N
a
7,L
CER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
LI M RIDGEWAY 12500 WA0171300
A
26
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED65901
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6185
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.
W/LLIAM RIDGEWAY 05-31-23 04:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 6/1/2023 6:18:13 AM
BADGE OR ID# 112500 ORI#' WA0171300 TIME POLICE DISPATCHED! 2:48 PM TIME POLICE ARRIVED',2:50 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED65901 CASE# 23-6185 OF COLLISION05/31/23 14:48
NARRATIVE
23-6185
At about 1415 hours on 05/31/2023, 1 on viewed a two-vehicle accident that occurred at N 3rd St. and
Pelly Ave N in the City of Renton, King County, Washington. Both vehicles had airbag deployment.
Unit 1 was a white 2022 Kia EV6 (DV18907/WA). The driver/owner was Michael R. Pokryfke
(DOB:06/18/1968-verified by WADL photo).
Unit 2 was a silver 2016 Subaru Forester (BNR8439/WA). The driver/owner was Ronald N. Lyter
(DOB:05/18/1958-verified by WADL photo).
Both parties were told they were being recorded.
I had FIRE respond due to air bag deployment. Ronald was seen and cleared by FIRE. Michael was
told his ribs may be broken but there would be no treatment required at the hospital and was cleared
by FIRE.
Bankers was dispatched and completed a private tow for Unit 1 and Unit 2.
1 spoke with Michael, who said he was stopped at Pelly Ave N and N. 3rd St at the stop sign. A
vehicle in lane 1 of N 3rd St stopped and waived Michael to proceed straight through N 3rd to
continue northbound on Pelly Ave N. Michael said Unit 2 came out of no where on N 3rd and struck
Unit 1 on the driver's side. Michael believed Unit 2 was going 80 mph. Michael said he was going
about 30 mph. Michael was wearing his seatbelt when the accident occurred.
I spoke with Ronald, who said he was going eastbound on N 3rd St in lane number 3, when a car to
his right slowed to let Unit 1 cross though N 3rd St from Pelly Ave N. By the time Ronald saw Unit 1, it
was too late, and the accident occurred. Ronald said he was wearing his seatbelt and he believed he
was going about 25 mph.
I observed extensive damage on Unit 1 on the entire left side of the vehicle. I observed extensive
damage on Unit 2 on the front end, causing fluids to lead onto the roadway.
I provided both parties with a business card, case number and exchange of information.
This concludes 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 W. Ridgeway#12500 on 05/31/2023 at 1629 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. ED65901 CASE# ' 23-6185 DATE AND TIME 05/31/23 14:48
OF COLLISION
P'ELLY AVE N
UNIT 2 UNIT 1
N. 3RD ST
PAGE 4 OF 4