HomeMy WebLinkAbout23-10071 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
CASE 23-10071 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 5 6 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 08 - 1-- 2023 1459 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a SE 182ND ST
0 6 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE O 11
30
6� LAST NAME MUZYCHUK FIRSTNAME ANDREY MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 12016 SE 186TH ST CITy RENTON ST WA 2jp, 980586615 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 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� BWR0239 sTArI WAurN# KM8J3CAtXLU278418
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 $ 34
13 2 2020 HYUN TUCSO DAMAGE vE8 ONO agW�MEYER vEs❑ No✓
REGISTERED OWNER INFO ANDREYMUZYCHUK 12016 SE 186TH ST RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME. 3
IN EFFECT &POLICY# � 9TOP
VEwcLE CHARGE 36
LEGALLY Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,DIING 8 7 6
UNIT U2 VEHIMOTDCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME YUSUF FIRST NAME GULEED MIDDLE JA
INITIAL
17❑ STREET ❑', 20245 111TH WAY SE CITY' KENT ST WA ZIP 980315565 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19 D IVEW # STATE WA SEX M M .C.B. 08 _ 21 1986 El 39
WELMET INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG,2 RESTR 4 EJECT '1 USE CLASS SHOULDER
21❑ LICENSE I CBX6657 TAre WA VIN# JM3KE2CY6E0372433
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE MAZp MODEL CX-5 STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO✓
REGISTERED OWNER INFO GULEEDYUSUF20245111THWAYSE KENTWA98031 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEG
25 io BOTTOM
ALLY YES ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97755
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10071
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.
M.LEVERTON 08-31-23 03:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 911112023 9:46:25 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 2:59 Pry TIME POLICE ARRIVED:2:59 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED97755 CASE# 23-10071 OF COLLISION08/31/23 14:59
NARRATIVE
unit 1/slv suv unit 2 maroon suv
RTF
Information/Insurance only
Within the city limits of Renton/King/WA I was working a 4 car blocking injury crash at 18100 108th
Ave SE when a 2 car crash happened at 18200 108th Ave SE-blocking injury.
I heard the boom of the two cars crashing at 18200 108th Ave SE. While I was at the 18100 crash
both lanes of NB 108th were blocked by cars involved in the 4 car crash. Northbound traffic on 108th
was using the 2WCLTL to by-pass the blocking traffic at 18100. 1 left the 4 car and went to the 2 car
to check on injuries and block the traffic lane.
I contacted the driver of unit 1 who told me he was slowing in his traffic lane southbound lane 2 and
was deciding if he was going to be able to make a left turn across NB 108th traffic when he was hit
front behind by unit 2. He did not complain of injury and damages did require a tow truck.
I contacted the driver of unit 2 who told me he thought unit 1 had actually stopped in the roadway and
he told me he was unable to stop/respond in time to avoid contact with unit 1. He did swerve and had
less of a direct impact to unit 1. He did complain of shoulder pain and I could see him fussing with his
shoulder. He was checked and released on scene by Renton Fire. Damages to his vehicle did
require a tow truck.
Information/insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 8/31/2023
PAGE 3 OF 4
REPORT NO. ED97755 CASE# ' 23-10071 DATE AND TIME 08/31/23 14:59
OF COLLISION
Onts
182nd Ave SE
PAGE 4 OF 4