HomeMy WebLinkAbout23-14360 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-14360 2 6 0
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL NG 3
HIT IT&RUN � CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' GUARDRAIL
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 12 - 1-- 2023 1533 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
SOUTHPORT DR N
e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF GARDEN AVE N
0 3 29
MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 a 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zlp 2
NEW ADDRESS
7❑ ODL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs No�/ YEs No�/
8❑ LICIENSE#
SrA fE I
SEX u MMDOBYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES 2❑
3
LICENSE UNKNOWN sTATI vrN#
10 1❑ pl ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR. YRLR 5 3 33
12 3 5 vIN#' UIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 3 34
13 3 2010 VOLK TIGUAN UT DAMAGE YES fn TO ves❑ NO
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
EHICLE CHARGE 1 5 36
v
LEcnLLv res❑NO❑ CITATION# 10 BOTTOM
El
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067071582
16 a
LAST NAME GRIDYUSHKO FIRST NAME ANIA MIDDLE A
INITIAL
17 STREET❑ NEW ADOREss❑' 1300 N 20TH ST K2039 CITY RENTON ST WA ZIP 98056 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YES❑NoF,/l I INTERLOCK YES❑NoF YES❑NO
19 DRIVER'S STATE WA ]SEX IF I D.C.B. 12 _ 27 1998 39
LICENSE# MMDDYY
H U EET LASSY CUT REOFINJURIE
TO INSIDE UPPER LIP ❑ 40
20 ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 6
❑21❑ PLATE# CGP2000 TATE 41
WA vIN# KNDEUCAASM7148693 4
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
Gov HI
VEH YEAR 2021 MAKE /qA MODEL SELTOS STYLE UT DAMAGE TOWE O YES
NO
D ES NO✓ B TOWED By 44
LIN
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU POLICY#E CO GEICO 6122895433IN 9TOP 5
VEHICLE YES❑ N
C[:] CITATION# CHARGE io BOTTOM
LEGALLY
25 s 7 a
BAD OFFICER'S NAME(PRINT) OFFICER PHONE GE OR ID# AGENCY
26
MATTHEW TRAINO 12811 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE33321
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14360
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ABDEL-RASSOUL AMEENA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1225 IN CASINO RD E1 EVERETT WA 98204 4254040547 SEX M MMDOYyry 02 - 16 - 2000
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ [Z POS. ' USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Id DOB
E MMDDYVYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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 TRAINO 12-14-23 05:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.MOYNIHAN 11288 12/22/2023 11:21:30 AM
BADGE OR ID# 112811 ORI# WA0171300 TIME POLICE DISPATCHED; 3:35 PM TIME POLICE ARRIVED',3:35 PM
PART I PAGE IT]OF 4]
REPORT NO. EE33321 CASE# 23-14360 OF COLLISION
12/14/23 15:33
OF CbLLI510N
NARRATIVE
At the listed date, time, and location, while employed as a uniformed Patrol Officer for the City of
Renton, I was conducting a patrol within the City of Renton, County of King, State of Washington. At
the intersection, I observed a black 2021 Kia Seltos (WA Plate CGP2000), which had struck a
guardrail and was facing eastbound on N Southport Dr.
I contacted the driver, identified by her WADOL as Ania A. Gridyushko (12/27/1998), who stated that
she was making a left turn from Lake Washington Blvd N to head eastbound on N Southport Dr.
According to Gridyushko, a white Volkswagen Tiguan (unknown plate) made a right-hand turn from
Garden Ave N to N Southport Dr, cutting off her direction of travel. Gridyushko said that she turned to
the right to avoid the collision with the Tiguan, and hit the guardrail.
The right-hand turn from northbound Garden Ave N is controlled by a red signal light. There is a
marked sign indicating that no turn on a red light is allowed.
I spoke with a witness, identified by his WADOL as Ameen A. Abdel-Rassoul (02/16/2000). He stated
that he was behind Gridyushko and observed the white vehicle cut her off, causing the collision. Both
Gridyushko and Rassoul said that they last saw the suspect vehicle heading eastbound.
Gridyushko reported minor injury, suffering a cut upper lip from the collision. Her Kia Seltos sustained
significant damage to the right front bumper, the right front suspension, the right-front tire, and the
right-front wheel. The driver side steering wheel airbag deployed during the collision.
I provided Gridyushko with her case number and advised her to contact her insurance company. The
Seltos was towed from the scene at Gridyushko's request.
Based on Gridyushko and witness Rassoul's statements, the unidentified owner of the Tiguan
appears to have caused the collision when the disregarded a traffic signal at the intersection. No
further suspect information is available at the time of this report.
N/F.
PAGE 3 OF 4
REPORT NO. EE33321 CASE# ' 23-14360 DATE AND TIME 12/14/23 15:33
OF COLLISION
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