HomeMy WebLinkAbout23-14936 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EE37454 170
27
COLLISION REP FIT 1591971
CASE 23-14936 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 12 - 1-- 2023 1303 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW GRADY WAY BLOCK NO. e✓ 101
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 175 00 FMILES EET e S ❑ W e RAINIER AVE S
0 4 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:2063830455 0 11
30
6� LAST NAME BAER FIRSTNAME STEVAN MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 3206 80TH AVE SE CITY MERCER ISLAND ST I WA 2jp, 980402935 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
8❑ DRIVERS
# STATE WA SEX'M MM D Y' 03 — 16 — 1955 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� AVD8548 sTArI WAurN# 1FADP3K25EL271631
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] $ 34
13 2 2014 FORD FOCUS DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO STEVAN BAER 320680TH AVE SE APT I MERCER ISLAND WA 98040 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE[Z INSURANCE CO GEICO 2025-67.82.99 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:4649617527
LAST NAME VOINYI FIRST NAME YAROSLAV MIDDLE N
INITIAL
17❑ STREET ❑', 120 BROADWAY UNIT 438 CITY' SEATTLE ST WA ZIP 981225969 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 F] DRIVER #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21❑ LICENSE I CFG0762 TAre WA vIN# JTDBT923X71129587
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2007 MAKE TOYT MODEL YARIS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ANDREI TEREKHOV2214 VASHONAVENERENTONWA98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL io BOTTOM
C(
LY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE37454
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14936
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
POS. 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'
blk/1 It across wht/2 lane 1
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash near the 100 block of SW Grady
Way.
I contacted the driver of unit 2 who told me he was eastbound SW Grady Way, lane 1 when unit 1
turned across this lane where they collided. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1. His son spoke for his as unit 1 driver was a mute. The son told me
that he was making a left into the Sound Ford parking lot where traffic was stopped eastbound and he
believed the lanes were clear. He did not complain of injury and damages did not 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 12/29/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-29-23 02:51 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 11512024 9:23:49 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 4:04 Pry TIME POLICE ARRIVED 4:07 Pry
PART I PAGE IT]OF
REPORT NO. EE37454 CASE# ' 23-14936 DATE AND TIME 12/29/23 13:03
OF COLLISION
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