HomeMy WebLinkAbout23-7009 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-7009 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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#
COLLISION.. 06 - 1-- 2023 1230 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
DUVALL AVE NE BLOCK NO. e✓ 2400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 24TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2062358142 0 11
30
6� LAST NAME KOVAL FIRSTNAME LIUDMYLA MIDDLE N 1 2 31
INITIAL
STREET ❑ 15368 SE 182ND ST C(TY RENTON ST WA ZIP' 980589690 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� /a6439625 sTArI WAurN# 3A4FY48BX6T365291
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR 2006 MAKE CHRY MODEL PT STYLE VEHICLE TOWEDNa pLSSBLIN T,QVyEq.BLRs yOS❑ENO✓ 1 5 34
13❑ DAMAGE LJI tSAlVilc
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO PATRIOT GENERAL 1140879791 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLYYES❑NO❑ CITATION# 3A0387733 FAIL TO YIELD MOTOR VEHICLE <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4257576684
16 a
LAST NAME HANSON FIRST NAME BAUER MIDDLE I L
INITIAL
17❑ STREET ❑', 8619 138TH PL SE CITY NEWCASTLE ST WA ZIP 980593497 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BRK4311 TAre WA vIN# 3(BNAXXEV8LS538270
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE CHEV MODEL EQUINOX STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO AJ HANSON&COINC 203 S ORCAS ST SEATTLEWA 98108 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO NATIONWIDE PA00163338-06IN 970E 5
'E""LE ❑ Nu,J CITATION# CHARGE to BOTTOM
LEGALLY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED72242
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7009
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PANCHOKHA OKSANA N
(/AST FIRST,
ADDRESS&PHONE# D O.B.
15368 SE 182ND ST RENTON WA 980589690 SEX F MMDDuyry 10 - 28 - 1992
PASSENGER WITNESS UNIT# I 1 SEAT 11POS. 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET NJURY NATURE OF INJURIES
USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) HANSON BRIDGET L
ADDRESS&PHONE# DOB
8619 138TH PL SE NEWCASTLE WA 980593497 SEX: F MMDDuvvv 03 _ O6 _ 2008
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 062023 1 responded to a 2-vehicle non-injury-blocking collision at Duvall Ave NE and NE 24th ST.
I contacted the driver of unit 2 who told me they were traveling in the # 2 lane of southbound on
Duvall Ave NE when unit 1 turned in front of him. The two vehicles collided in the in the intersection.
The driver of unit 2 was not injured nor was the passenger. His vehicle sustained front end damage
and required towing.
I contacted the driver of unit 1, identified as Luidmyla Koval (dob 08-01-72) via her WA DL. Koval
says she was making a left turn from eastbound NE 24th to northbound Duvall Ave NE. Koval did not
see unit 2 coming when she pulled out onto Duvall Ave NE. Both Koval and her front seat passenger
said they were not injured. The damage to unit 1, (front-end), required an impound.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Koval via SECTOR under RCW 46.61.180.1 -Failure to Yield
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-20-23 03:20 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 612112023 10:33:45 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 12:30 PM TIME POLICE ARRIVED 12:35 PM
PART I PAGE IT]OF 3�
REPORT NO. ED72242 CASE# 23-7009 DATE AND TIME 06/20/2312:30
OF COLLISION
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