HomeMy WebLinkAbout23-7243 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED74120 170
27
COLLISION REP FIT 1591971
CASE 23-7243 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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 06 - 1-- 2023 1357 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:2068509756 0 11
30
6� LAST NAME CHIBUEZE FIRSTNAME GENAVIVE MIDDLE O 1 1 2 31
INITIAL
STREET ❑1 30819 124TH AVE SE APT D302 CITY AUBURN ST I WA 2jp, 98092 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES �No /
❑ DRIVER'S' STATE MM SEX'F MM ovY' 05 - 02 - 1969 1 2 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
U EET IINLJA NA
URY 1 [!!RE OF INJURIES z❑
3
10 1❑ P1 ATE 14 BRU4416 STATE WA VIN# 2T2BK1BA2CC136764
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 5 33
12 0 0 VIN#' VIN#'
;.... FROM TO
VEH.YEAR 2012 MAKE LEXS MODEL RX STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ANTHONY CHIBUEZE 12435 SE 208TH ST KENT WA 98031 D:2063741837 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 966260911 3 4
IN EFFECT &POLICY# 9TOP
❑ LVEHicLe CHARGE 1 5 36
15 2 srnNoiNG YES No CITATION# 3A0095099 IMPROPER LANE USAGE o eorrob
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2533741837
16 a
LAST NAME REDDY FIRST NAME ELVIRA MIDDLE I C
INITIAL
17 NEW STREETR 7 2205 S 312TH ST APT C26 CITY FEDERAL WAY ST WA ZIP 980035020 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK yEs I I NOF YES t l NOF,/
19 DRIVER # STATE WA SEX F M.C... 01 21 1977 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAU EY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CBY1730 TATE WA VIN# 41
STDZZ3DC7JS927076 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
I 44
VEH YEAR 2018 MAKE 7'Dy7' MODEL SIENNA STYLE VN DAMAGE TOWED NOO✓ BLIN TOWED BY Gov HyES NO
24❑ YES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04623702067IN 1 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ALEKSANDRIGNATOV 12619 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED74120
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7243
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CH/BUEZE ANTHONYA
(LAST FIRST,
ADDRESS&PHONE# D.0.B.
30819 124TH AVE SE APT D302 AUBURN WA 980923360 2068509756 SEX M MMDDYYYY 04
PASSENGER Z WITNESSED] UNIT# 1 SEA 3 AIRBAG:2 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES
pos. USE CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
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'
Unit one was traveling westbound on SW Grady WAY in lane 2 of 3. Unit two was traveling
westbound on SW Grady WAY in lane 1 of 3 (left turn lane to go southbound on Oakesdale Ave SW).
Unit one made an unsafe lane change from lane 2 of 3 into lane 1 of 3 and struck unit two.
Photos uploaded to Axon Evidence. Unit one cited with an infraction.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ALEKSANDR IGNATOV 06-26-23 03:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.SKELTON 9139 612712023 4:26:02 AM
BADGE OR ID# 12619 ORI# WA0171300 TIME POLICE DISPATCHED 1:59 PM TIME POLICE ARRIVED;Y:07 Pry]
PART I PAGE IT]OF 3�
REPORT NO. ED74120 CASE# ' 23-7243 DATE AND TIME 06/26/23 13:57
OF COLLISION
OAKESDALE AVE SW
07
'D
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