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Home My WebLink About23-12198 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c COLLISION REP FIT 1591971 CASE 23-12198 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 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 10 - 1-- 2023 2134 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RENTON AVE EXT BLOCK NO. e✓ 200 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e TAYLOR AVE NW 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2063481552 0 11 30 6❑ LAST NAME MOBIL FIRSTNAME TARAS MIDDLE J 1 2 31 INITIAL STREET ❑ 3000 ROYAL HILLS DR SE#8G CITy RENTON ST WA ZIP 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES 1/ NO 8❑ LDRIVER # STATE WA SEX'M MID ELOB 09 1- 09 - 1971 2 32 [NATURE OF INJURIES 9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 . EJECT 1 HELMETU E 2 CLASS ,7 COMPLAINT OF CHEST PAW z❑ 3 LICENSE CCM1873 sTArI WAurN# KMHCM36CX9U105733 10❑ PI ATE 14 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro TRLR. TRLR 3 5 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 2 2009 HYUN ACCENT SD DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE Z INSURANCE CO STATEFARM 5375077D2447 4 IN EFFECT &POLICY# 9TOP VEwcLE CHARGE 5 36 LEGALLv YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067628539 16 a LAST NAME NIKOLAISEN FIRST NAME DAVID MIDDLE JA INITIAL 17 STREET❑ NEW ADOREss❑' 712 S KENYON ST CITY SEATTLE ST WA ZIP 98108 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt—T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,—/] 19 DRIVER'S STATE WA SEX M D.C.B. 07 22 _ 1969 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ 41 21❑ PLATE# SL4YER TArE WA VIN1t 4T1B11HK5JU631835 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. GI VEH YEAR 2018 MAKE 7'Dy7' MODEL CAMRY STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 1/ 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGED AREA 3 4 LIABILITY INSURANCE INSU PORGY#E CO GEICO 4196 08 32 00IN 9TOP 5 0( V'""LE ❑ ,J� CITATION# CHARGE to BOTTOM LEGALLY YES N`L J 25 ' 6 =ORAJEWSKI (PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12399 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE13733 COLLISION REPORT III III III III III 111 1591972 CASE# 23-12198 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MOBIL HALYNA (LAST FIRST, ADDRESS&PHONE# D O.B. 3000 ROYAL HILLS DR SE#8G RENTON WA 98058 SEXi F MMDOYyvv 01 - 14 - 1973 SEAT HELMET NJURY NATURE OF INJURIES PASSENGER�WITNESS�,UNIT# 1 POS. 3 AIRBAG',6 RESTR. q EJECT 1 USE 2 iCLAS5 17 CHEST AND LEFT KNEE PAIN NAME (LAST,FIRST,MIDDLE INITIAL) MOBIL RUTA M ADDRESS&PHONE# D O B 3000 ROYAL HMS DR SE#8G RENTON WA 98058 SEX: F MMDDvvvv 01 _ 18 _ 2007 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.Q.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. RAYMOND GORAJEWSK/ 10-24-23 11:17 PM INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 1012712023 6:22:14 PM BADGE OR ID# ! 1Y399 OR]# WA0171300 TIME POLICE DISPATCHED; 9:38 PM TIME POLICE ARRIVED',9:43 PM PART I PAGE IT]OF 5� REPORT NO. EE13733 CASE# 23-12198 OF COLLISION 10/24/23 21:34 OF CbLLI510N NARRATIVE ASSIGNMENT/ARRIVAL On 10/24/2023 at approximately 2138 hours, I was dispatched to a two-vehicle collision at the intersection of Renton Avenue Extension and Taylor Avenue NW in the city of Renton, King County, Washington. I arrived at approximately 2143 hours. UNIT 1: HYUNDAI ACCENT Upon arrival I observed a green Hyundai Accent (WA/ CCM1873, Unit 1) stopped facing north in the intersection. Unit 1 had moderate damage to the passenger side. UNIT 2: TOYOTA CAM RY I observed a gray Toyota Camry (WA/ SL4YER, Unit 2) stopped facing east in the number one (closest to curb) eastbound lane of Renton Avenue Extension east of the intersection of Taylor Avenue NW. Unit 2 had moderate front end damage. DRIVER 1: MOBIL, TARAS J. I contacted Taras J. Mobil (DOB: 9/09/1971) standing near Unit 1. 1 identified Taras by his valid Washington Driver License. I established Taras as the driver of Unit 1 by his admission. Taras complained of chest pain from the collision and was eventually transported by ambulance to Valley Medical Center. PASSENGERS I contacted two passengers who were in Unit 1, Ruta M. Mobil (DOB: 01/18/2007) and Halyna Mobil (DOB: 01/14/1973). Ruta was not injured from the collision. Halyna complained of chest and left knee pain from the collision. Halyna was transported by ambulance to Valley Medical Center. DRIVER 2: NIKOLAISEN, DAVID A. I contacted David A. Nikolaisen (DOB: 07/22/1969) standing near Unit 1. 1 identified Nikolaisen by his valid Washington Driver License. I established him as the driver of Unit 2 by his admission. STATEMENT: MOBIL, TARAS J. I spoke with Taras about the collision. The following is a summary of our conversation: Taras was driving Unit 1 west on Renton Avenue Extension to turn south (left) onto Hardie Avenue NW. Taras stopped at the circular, yellow traffic signal. Taras did not see any vehicles approaching, so he turned into the intersection. Taras saw Unit 2 driving east on Renton Avenue Extension toward him just before Unit 2's front end collided with Unit 1's passenger side. This concluded my conversation with Taras. STATEMENT: NIKOLAISEN, DAVID A. I spoke with David about the collision. The following is a summary of our conversation: David drove Unit 2 east on Renton Avenue Extension toward Taylor Avenue NW/Hardie Avenue NW at approximately 30 -35 miles per hour in the number two (closest to center) lane. David had a solid, circular green traffic signal. As Unit 2 approached the intersection, David said Unit 1 turned right (east) from Hardie Avenue NW onto Renton Avenue Extension. Unit 2 collided with Unit 1. I believe David was mistaken in his belief he saw Unit 1 turn from Hardie Avenue NW. If that were true, Unit 1's damage would be on the driver side. This concluded my conversation with David. DISPOSITION PAGE 3 OF 5 REPORT NO. EE13733 CASE# 23-12198 OF COLLISION 10/24/23 21:34 OF CbLLI510N NARRATIVE Both vehicles were towed away at the owners' request. I gave both drivers an Exchange of Information form. This concluded my involvement in 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 Officer R. Gorajewski, #12399, on 10/24/2023 at 2314 hours in Renton, Washington. PAGE 4 OF 5 REPORT NO.! EE13733 CASE# 23-12198 DATE AND TIME 10/24/23 21:34 OF COLLISION Taylor Ave.NW wq Y rrr sk.m A Not to Scala Fen#fln AVC Ci52 $# � I Hardie Avenue NW PAGE 5 OF 5