HomeMy WebLinkAbout23-14377 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-14377 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 03 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 12 - 1-- 2023 1848 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 17803
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067473792 0 81
30
6❑ LAST NAME VASYL FIRSTNAME HALAS MIDDLE 1 2 31
INITIAL
STREET ❑ 1116 108TH AVE E CITY EDGEWOOD ST WA 2jp, 98372 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 12 1- 24 - 1994 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ PICENS11 ATE 14 CEC6523 STATE WA V N# 1 GCFG15X131182632
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR 2003 CHEV EXPRES MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ BS GOVT.VEHICLE 9 9 34
13 4 DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO ANDRII ZAN 3000 ROYAL HILLS DR APT-D6 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 965361696 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:4256237576
16 2
LAST NAME LY FIRST NAME COUNG MIDDLE
INITIAL
17❑ NEW STREETR 14511 S
7 E 153RD PL CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE I WA SEX M I D.C.B. 04 19 _ 1978 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# BTR8431 TATE 41
WA VIN# 2T3F1RFV1LC090565 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
y GI
VEH YEAR 2020 MAKE TOYT MODEL RAV4 STYLE DEHICLE AMAGE ✓TOWED TO
BLIN NONE rowed B ov HYES No%/ 44
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 201924744406IN STOP
VE""LE CITATION# CHARGE to BOTTOM
LEGALLY YES Nu
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
N AAH G/RELLO 12607 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE36266
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14377
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.
NOAH GIRELLO 12-15-23 02:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 11112024 7:56:56 PM
BADGE OR ID# 12607 ORI# WA0171300 TIME POLICE DISPATCHED 6:51 PM TIME POLICE ARRIVED',7:01 PM
PART I PAGE IT]OF
REPORT NO. EE36266 CASE# 23-14377 OF COLLISION
12/14/23 18:48
OF CbLLI510N
NARRATIVE
23-14377
At about 1851 hours on 12/14/2023 1 was dispatched to a 3-car blocking collision at, 17803 108th Ave
SE, in the city of Renton, King County, Washington. Dispatch advised me that the Collison occurred
in the south bound lane one 108th Ave SE just north of the intersection of 108th Ave SE and SE
180th ST. Dispatch advised there were no injuries, but they were blocking 1 of 2 south bound lanes.
Unit 1: White 2003 Chevy Express G1500 LIC/CEC6523 VIN/1GCFG15X1 31 1 82632
Driver: Vasyl Halas (DOB 12/24/1994) via WADL
Unit 2: Grey 2020 Toyota RAV4 LIC/BTR8431 VIN/2T3F1 RFV1 LC090565
Diver/RO: Cuong Ly (DOB 04/19/1978) via WADL
Unit 3: Black 2021 Mazda CX-5 LIC/BZY7040 VIN/JM3KFBCM6M0442067
Driver/RO: April Solares (DOB 03/28/1992) via WADL
The following is a summary of what unit 1 said happened. Unit 1 said he was traveling south on 108th
Ave SE in the #1 lane as he approached the intersection of 108th Ave SE and SE 180th ST. Unit 1
said there was traffic in front of him and the traffic stopped abruptly, and he had dust in his eye, so it
distracted him, and he couldn't stop in time. Unit 1 hit unit 2 from behind with the front of his vehicle.
Unit 1 had severe damage to the front of his vehicle.
The following is a summary of what unit 2 said happened. Unit 2 said traffic in front of him slowed and
stopped so he stopped. Unit 2 said his vehicle was completely stopped and was not moving when
unit 1 hit him from the back causing unit 2 to rear end unit 3. Unit 2 had minor damage to both the
front and back of his vehicle.
The following is a summary of what unit 3 said happened. Unit 3 said she had come to a complete
stop because the traffic at the intersection in front of her had backed up. Unit 3 also said she was
completely stopped and was not moving when unit 1 rear ended unit 2 which cause unit 2 to rear end
unit 3. Unit 3 had minor damage to the rear of her vehicle.
There were no other identified witnesses of the accident, and I did not see any video cameras in the
area. Unit 1 had severe damage and need a tow and was later towed by Bankers Towing Company.
Units 2 and 3 had minor damage and were still drivable. Each driver involved in the accident received
a business card with a case number.
This incident was captured by my body worn video camera. This report is a summary of the events
that occurred and is not an exact sequencing of events. Statements have been summarized and
paraphrased.
This concludes my involvement with this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by N. GIRELLO #12607 on 12/14/2023 at 2000 Renton, WA
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE36266
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-14377
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE _) PEDESTRIAN � OWNER � YES NO
D:3233632063
rFO 8 29
LAST NAME SOLARES FIRST NAME : APRIL MIDDLE
INITIAL
STREET 30
❑ NEW AnDRFrtP 2223 BENSON RD S APT-T203 CITY RENTON ST WA ZIP 98055
6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs NO NTERLOCK YES❑N0� vES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv', 03 - 28 - 1992
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BZY7040 TAr Wq VIN# JM3KFBCM6M0442067
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 0 0 VEH.YEAR2021 MAKE MAZD MODEL CX-5 STYLE VEHICLE TOWS E T SABLI TEED BY anvi vFH1I' P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER J 9 33
12 � SHADE IN DAMAGED AREA
3 4 FROM TO
LIABILITY INSURANCE INSURANCE CO STATEFARM 482 0891 Ft i 478 q"i"Olx
IN EFFECT &POLICY# 1
VEHICLE 34
13 4 Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM
STANDING } 8 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE rnr VIN# 39
PLATE#
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LECALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NOAH GIRELLO 12-15-23 02:57 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OBADGE R ID# 12607 O#I',WA0171300 APPROVED By 111112024 PAGE I OF F
3000-345-013(R 11118)
REPORT NO. EE36266 CASE# ' 23-14377 DATE AND TIME 12/14/23 18:48
OF COLLISION
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