HomeMy WebLinkAbout23-12085 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12085 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 10 - 1-- 2023 1909 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SHATTUCKAVE S
0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2063977903 0 11
30
6� INITIAL
LAST NAME RAHMAN FIRSTNAME SADIQUR MIDDLE 1 1 2 31
STREET ❑ 6009 ELIZABETH AVE SE CITY AUBURN ST WA 2jp, 98092 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
LOB 07 1- 11 - 1988 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� AKZ4368 sTArI WAvIN# JTDKB20U267072156
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 3 2006 TOYT PRIUS SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 INSURANCE CO 3 4
14 LIABILITY INSURANCE PEMCO CA2103545
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 10 BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064122425
16 a
LAST NAME STADNIKOV FIRST NAME JOSEPH MIDDLE Y
INITIAL
17 STREET❑ NEW ADDREss❑' 1803 SE 8TH ST CITY RENTON ST WA ZIP 98057 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 10 _ 01 2006 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BMZ7350 TArE 41
WA vIN# JA4AZ3A31JZ062311 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE MITS MODEL OUTLAN STYLE SI/ VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO YURIYSTADNIKOV1803 SE8THST RENTON WA 98057 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 920969086IN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE13160
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12085
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'
On 10/22/2023 at 1915 hours I was dispatched to a collision at the 300 blk of S Grady Way. I spoke
with the driver of Vehicle 2 who stated that he was traveling East on S Grady Way approaching the
intersection of Shattuck Ave S and was proceeding through the intersection with a green light while in
the number 2 lane. The driver of Vehicle 2 stated that he observed Vehicle 1 traveling West on S
Grady Way and was performing a U-turn at the intersection of S Grady Way and Shattuck Ave S to
proceed East on S Grady Way. The driver of Vehicle 2 stated that Vehicle 1 made the U-turn and
stopped in the roadway just East of the intersection for an unknown reason while partially in the
number 2 lane. The driver of Vehicle 2 stated that he did not have time to stop and did not have a
reasonable place to avoid the collision. The driver of Vehicle 2 stated that Vehicle 2 made contact
with Vehicle 1 by colliding into the rear driver side bumper of Vehicle 1 with the passenger side door
of Vehicle 2. 1 spoke with the driver of Vehicle 1 and he stated that he was making a U-turn at the
intersection of S Grady Way and Shattuck Ave S and was facing West on the lefthand turn lane. The
driver of Vehicle 1 stated that he made the U-turn and was going to proceed East on S Grady Way
from Shattuck Ave S when he felt Vehicle 2 make contact with Vehicle 1 by colliding into the back
driver side bumper of Vehicle 1 with the passenger side door of Vehicle 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 10-22-23 08:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS solo 1 10/26/2023 5:53:37 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 7:15 PM TIME POLICE ARRIVED',7:20 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE13160 CASE# ' 23-12085 DATE AND TIME 10/22/23 19:09
OF COLLISION
Shattuck Ave.S 61
rlL
I.° S Grady Way'
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