HomeMy WebLinkAbout23-9637 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9637 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 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 08 - 1-- 2023 1611 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
OAKESDALEAVESW ST e✓
MILEPOST 4200 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a SW 43RD STREET
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ D:2533505908 0 9 30
6� LAST NAME GAZHENKO FIRSTNAME ANDREW MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 12713 SE 276TH PL CITY KENT ST WA 2jp, 980308896 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C375752 sTATI WAurN# 1 FT7W26T7JE613013
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 2018 FORD F250 PK DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO GIG HOMES INC 491 SPRING VIEW PL CHELAN WA 98816 D:2533505908 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 3 4
14 2 LIABILI INSURANCE INSURANCE CO STATE FARM 473.0647-A24.47
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 10 BOTTOM 5 36
LEGALLY YES No CITATION# W23010282,W23010282 FOLLOW VEHICLE TOO CLOSELY,
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2069459765
LAST NAME NDAYE FIRST NAME OLIVER MIDDLE
INITIAL
17❑ NEW STREETR 2206 S 7 234TH ST APT C304 CITY DES MOINES ST WA ZIP 981982740 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YEs I'✓ No❑
19 DRIVER'S STATE WA SEX F D.C.B. 01 01 2000 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 6 C/O BACK PAINETRANSP.TO VMC ❑ 40
❑ILICENSE 21❑ PLA E# BXU0487 TATE 41
WA VIN# 5FNRL384078028514 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2007 MAKE HOND MODEL ODYSSEY STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO BYAMUNGUMWEMA4822S252NDPLAPT202 KENTWA98032 D:2069459765 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO GEICO 6127-70-57-77IN 1 9TOP
'E""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES Nu
❑ s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97760
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9637
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.
MATTHEW NUGENT 08-22-23 06:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 911112023 7:36:50 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 4:14 PM TIME POLICE ARRIVED 4:21 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED97760 CASE# 23-9637 OF COLLISION08/21/23 16:11
NARRATIVE
23-9637
On 08/21/2023 at approximately 1614 hours, I was dispatched to a vehicle collision with reports of
injury at the intersection of Oakesdale Ave SW and SW 43rd Street, within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised that the Renton Regional Fire Authority (RRFA) would be
responding due to the reports of injury.
Upon arrival, RRFA was already on scene evaluating the involved parties. There, I collected each of
the involved parties driving documents and their independent recollection of the events leading up to
the collision.
The driver of Unit#1 said he was the sole occupant of his company vehicle and was traveling
southbound in about the 4200 block of Oakesdale Ave SW approaching the intersection of SW 43rd
ST in lane 1 of 3. The driver of Unit#1 stated he was traveling directly behind Unit#2 and saw as Unit
#2 had suddenly stopped for an emergency vehicle that was approaching the intersection from the
east. The driver of Unit#1 was unable to stop in time subsequently colliding with the rear of Unit#2
causing minor damage to the front of Unit#1. It should be noted that the driver of Unit#1 was towing
behind a large flatbed trailer, and although Unit#1 was in lane 1 of 3, the driver stated he was
intending to make a right turn at the intersection and began to make a wide turn utilizing both lane 1
and lane 2 to make the wide turn at the intersection.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling
southbound in about the 4200 block of Oakesdale Ave SW approaching the intersection of SW 43rd
ST in lane 2 of 3. With the help of her husband translating, the driver of Unit#2 stated that she came
to a stop for an emergency vehicle that was approaching the same intersection, but from the east,
with emergency lights and siren activated. The driver of Unit#2 stated that while stopped, Unit#1
collided with the rear of Unit#2 causing moderate damage to the rear door hatch of Unit#2. The
driver of Unit#2 complained of back pain and was later transported to Valley Medical Center (VMC)
via ambulance for further evaluation.
Based on the above statements, I determined that the Driver of Unit#1 (Gazhenko) was the
predominant factor for the cause of collision due to Following Too Closely causing a collision. I issued
Gazhenko a written warning for Following Too Closely. Additionally, Unit#1 had an unlicensed trailer
attached to its vehicle which should have been properly licensed with a plate issued by the Dept. of
Licensing. The driver of Unit#1 stated that it was a company trailer, and he was unsure why the
license plate was not affixed. I issued Gazhenko a written warning for the unlicensed trailer.
All of the involved vehicles were able to be driven away without further incident. An exchange of
information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 5:05 PM 8/22/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED97760 CASE# ' 23-9637 DATE AND TIME 08/21/23 16:11
OF COLLISION
f�
V 1
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Tiagtam not to scale
Unit t t
Unit#2 cc
SW`43rd ST
PAGE 4 OF 4