HomeMy WebLinkAbout23-148 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CRSE# 23-148 2 0 7
INTERSTATE CITY STREET ✓ RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3❑HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 0951 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
140TH WAY SE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e SE 158TH ST
0 1 29
UNIT 01 VEHICLE
MOTPI PEDAL-ORCYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 81
30
6 LAST NAME CRUZ GONZALEZ FIRST NAME ADRIAN MIDDLE N 1 2 31
INITIAL
STREET ❑ 13617 SE FA/RWOOD BLVD CITY RENTON ST WA ZIP 980586954 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES 2❑
3
10❑ PI ATFBit BMV6278 sTArr~ WA urN#' 2HNYD18894H542958
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2004 ACUR MDX DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO MELQUTADEZ CRUZ-HERNANDEZ 58 SHATTUCK AVE S RENTON WA 98057 D:4259062180 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LECALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,"' 8 6
UNIT 02 VEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
[:]I DYES✓ NO OLD MET PHONE
16 a
LAST NAME SALOMOV FIRST NAME RAMAZON MIDDLE
INITIAL
17❑ STREET ❑', 8360 118TH ST APT 5H CITY' KEW GARDENS ST' NY ZIP 114150000 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVER'S STATE NY SEX M I D.Q.B. 12 _ 19 _ 1998 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHN6260 TArE WA VIN# 3FA6POHR3DR350954
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE FORD MODEL FUSION STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO RUSTAM MUKHAMMADIEV 10425 SE 206TH PL KENT WA 98031 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#ECO ALLSTATE 820 503 420IN I STOP
VE""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N�
❑ s
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. EE39524
COLLISION REPORT III III III III III 111
1591972 CASE# 23-148
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'
gry sedan/2 stops for yellow lane 2 slv suv/1 didnt stop in time
RTF
Within the city limits of Renton/King/Wa I responded to a 2 car blocking at the intersection of SE
140th Way at SE 158th St.
I contacted the driver of unit 2 via a phone translater who told me he stopped for the yellow light
northbound lane 2 on 140th when he was hit from behind by unit 1. He did not complain of injury and
damages did not require a tow truck.
I contacted the driver of unit 1 who told me he was behind unit 2 and believed unit 2 had enough time
and so did he to get through the intersection when unit 1 stopped. Unit 1 told me he slammed on his
brakes and tried to swerve to avoid contact but hit the back of unit 2. 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 1/5/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 01-05-24 03:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 111112024 2:09:10 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 9:51 AM TIME POLICE ARRIVED';9:56 AM
PART I PAGE IT]OF 3�
REPORT NO. EE39524 CASE# ' 23-148 DATE AND TIME 01/05/24 09:51
OF COLLISION
3 "+
� CI
I
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