HomeMy WebLinkAbout23-10569 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE02567 170
27
COLLISION REP FIT 1591971
CASE 23-10569 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 09 - 1-- 2023 1730 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 1900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ MILE N�,❑ FEET e S ❑ E e CEDAR RIVER PARK DR
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533472767 0 11
30
6❑ LAST NAME SIDOR FIRSTNAME ANDREY MIDDLE V 1 1 2 31
INITIAL
STREET ❑ 28120 SE 384TH ST CITY ENUMCLAW ST I WA 2jp, 98022 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 08 1— 10 — 1987 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� CDX1725 sTArI WAurN# JA3AJ26E37U017618
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 5 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 3 2007 MITS LANCER SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO YEVHENI CHEKANIN 10923 SE 183RD CT RENTONWA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO DAIRYLAND 11408812903 3 4
IN EFFECT &POLICY# 9TOP
EILe 1 5 36
LvE�ALHCLv YES�No� CITATION# W23028186 CHARGE PROH/IMPROPER TURN )o eorrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:3607612209
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME SANCHEZ FIRST NAME MICHAEL MIDDLE A
INITIAL
17❑ STREET ❑', 39603 258TH AVE SE CITY ENUMCLAW ST WA ZIP 98022 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t t— l No❑
19 DRIVER'S STATE WA SEX M D.C... 10 _ 29 _ 1988 39
LICENSE# MMDDYY
HELMET {NJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CDS1352 TAre WA vIN# WVWGV7AJ9CW261774
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED eY Gov HI 44
VEH YEAR 2012 MAKE VOLK MODEL (DTI STYLE 2H DAMAGE TOWED✓ NOO BLIN BANKERS YES No%/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 935862238IN 1 970E 5
'E ❑ ITATION# CHARGE
25 io BOTTOM
LEGALLY YES N Cl
' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
D.LAMOTHE 11677 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE02567
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10569
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.
D.LAMOTHE 09-13-23 06:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 9/26/2023 11:58:33 AM
BADGE OR ID# 11677 ORI# WA0171300 TIME POLICE DISPATCHED 5:36 PM TIME POLICE ARRIVED',5:36 PM
PART I PAGE IT]OF 4�
REPORT NO. EE02567 CASE# 23-10569 OF COLLISION
09/13/23 17:30
OF CbLLI510N
NARRATIVE
On the above listed date and time, I observed Vehicle #1 and Vehicle #2 pulled over on the south
shoulder of the east bound lane of travel in the 1900 block of Maple Valley Highway, in the City of
Renton, County of King, State of Washington. Both vehicles had visible damage along with their
flashing hazard lights on.
I observed that the front bumper of Vehicle #1 was missing and there was moderate damage to the
front passenger side corner.
I observed moderate damage to the front the front driver side corner of Vehicle #2, multiple scrapes
and dents to teh rims on the passenger side and the interior airbags deployed.
I spoke to Driver#1 who, stated he was traveling eastbound in the #3 lane (closest to the median).
He stated he changed from the #3 to the #2 lane and was in the process of attempting to merge into
the #1 lane so that he could make a right hand turn onto Cedar River Park Dr. In the process of
turning, he impacted with Vehicle #2. Driver#1 stated he was uninjured.
I spoke to Driver#2, who stated that he was traveling eastbound in the #3 lane, when Vehicle #1
merged into the front driver side of his vehicle, forcing his vehicle to strike the curb on his right. Driver
#2 stated me felt a little sore, but was uninjured.
Vehicle #2 was towed from the scene by Bankers Towing.
Driver#1 was issued a written warning for an improper turn/merge.
I conducted an exchange of information for both parties.
This concludes my involvement in this case.
PAGE 3 OF 4
REPORT NO. EE02567 CASE# ' 23-10569 DATE AND TIME 09/13/23 17:30
OF COLLISION
I-405 on ramp
Maple,Valley::Highway
1-405 off ramp: Y•
Park PI
PAGE 4 OF 4