HomeMy WebLinkAbout24-108 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-1o8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 01 - 1-— 2024 0825 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 18000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FEET e S MILES N B W e SE 181ST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065108886 0 11
30
6� LAST NAME ILLIUK FIRSTNAME VLADYSLAV MIDDLE N 1 2 31
INITIAL
STREET ❑ 24615 64TH AVE S APT F105 CITY KENT ST WA ZIP 980326376 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 CHW1796 STATE WA u N#' WAUFFAFLXBA063844
TRAILER STATE TRAILEFd STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. A'RLA2 1 3 33
12 3 5 VIN#j VIN#'
FROM TO
VEH.YEAR 2011 AUDI A4 P4 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO VLADYSLAVILL..61564THAVESAPTF105 KENTWA98032 D:2065108886 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO <53 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 5 36
LEGALLv Yes NO CITATION# 4AO087728 NOINSURANCEOTTOM
15❑ STANDING 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT a2 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2063030800
VEHICLE CYCLE OWNER 16 a
LAST NAME GEBREMARIAM FIRST NAME BRUKTITE MIDDLE I T
INITIAL
17❑ STREET ❑', 24319 99TH AVE S CITY KENT ST WA ZIP 980305396 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 DRIVER'S STATE WA SEX F D.C.B. 01 27 1986 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BFH0253 TATe 41
WA vIN# 4S4BSACC9H3374093
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. 'IN#.
VEH YEAR 2017 MAKE SUBA MODEL OUTBAC STYLE 4N/ VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO BRUKTITE GEBREMARIAM 2431999TH AVE S KENT WA 98030 D:2063030800 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 900644383IN IGQO,
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`E]
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
QUINT TIBEAU 07691 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE38143
COLLISION REPORT III III III III III 111
1591972 CASE# 24-108
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VLADSLAV IVAN
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
24615 64TH AVE S#F105 KENT WA 98032 2065108886 SEX M MMDOYyry 10 - 22 - 2005
PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
L�!1 1 POS, 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
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.
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.
QUINT TIBEAU 01-04-24 12:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 11812024 3:58:23 AM
BADGE OR ID# 07691 OR]# ! WA0171300 TIME POLICE DISPATCHED 8:28 AM TIME POLICE ARRIVED',8:31 AM
PART I PAGE IT]OF 4]
REPORT NO. EE38143 CASE# 24-108 OF COLLISION
01/04/24 08:25
OF CbLLI510N
NARRATIVE
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
On 01/04/24 at about 0828 hours I was flagged down about a two-vehicle collision in the 18000 block
of 108th Ave SE. I arrived at about 0831 hours to see two vehicles blocking the outside lane of
northbound 108th Ave SE.
The driver of vehicle #1 identified himself as Illiuk Vladyslav with his WADL. He stated that he was
driving northbound on 108th Ave SE when he saw a vehicle approaching him westbound on SE 181st
St. Vladyslav accelerated to avoid being hit by this vehicle and struck the rearend of vehicle #2
ahead of him. Vladyslav stated that he did not have insurance.
The driver of vehicle #2 identified herself as Bruktite Gebremariam with her WADL. She stated that
she was northbound on 108th Ave SE when she was rearended by vehicle #1.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Q. Tibeau 01/04/04 1058 hours, Renton, WA.
PAGE 3 OF 4
REPORT NO. EE38143 CASE# ' 24-108 DATE AND TIME 01/04/24 08:25
OF COLLISION
Not to Scale
PAGE 4 OF 4