HomeMy WebLinkAbout24-265 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# z4-zss 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&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 CITY# ❑
COLLISION.. 01 — 08 — 2024 1652 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE NE BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FEET MILES e S B W e NE 4TH ST
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES
NO ,/ D:8325668851 0 11
30
6� LAST NAME GOLCU FIRSTNAME MUKREMIN MIDDLE 1 2 31
INITIAL
STREET ❑✓ 18307 92ND AVE E CITY PUYALLUP ST WA Zjp, 98375 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NOWINTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 05 1- 14 - 1995 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ PI ATE14 CBt2338 STATE WA uN#' 4T1BD1EB2FU044429
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# IR.. ro
TRLR. TRLR $ 7 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR 2015 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34
13 4 TOYT AVALON SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER WFO MUKREMIN GOLCU 1830792ND AVEE PUYALLUP WA 98375 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 955521935 3 4
IN EFFECT &POLICY# 9TOP
LEGAEHA"LE 5
LLLY re5�No D CITATION# 4g0091141 CHARGE 36 INATTENTIVE DRIVING I o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT U2 ❑✓ ❑ PEDESTRIAN ❑ ❑ HO 2532598275
VEHICLE CYCLE OWNER YES NO �/
16 a
LAST NAME VO FIRST NAME THI MIDDLE I L
INITIAL
17❑ NEW STREETREs7 11410 SE PETROVITSKY RD CITY RENTON ST WA ZIP 980555668 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK yEs❑NOF YEs❑NoF,/
19 D IVERI # STATE WA SEX F Mr D.C.B. 03 _ 22 _ 1985 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CFX3752 TATE WA VIN# 41
JTDKN3DP6D3043426 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2013 MAKE 7'Oy7- MODEL pRIUS STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#ECO STATE FARM 5354094-C1b47IN STOP 5
0(
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE39317
COLLISION REPORT III III III III III 111
1591972 CASE# 24-265
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 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'
I was dispatched to the collision on 01/08/24 at 1657 hours at Union AVE NE and NE 4th St in city
Renton, King County WA.
Unit 1 CBL2238 Driver Mukremin, Golcu (05/14/1995)
Unit 2 CFX3752 Driver Thi, L. Vo (03/22/1985)
Both drivers were identified by their WADL.
Unit 1 was stopped on Union AVE NE making a left hand turn into the back parking lot of Firestone.
When Unit 1 turned left through two vehicles that were stopped in Southbound traffic on Union Ave
NE, he got struck by Unit 2. Unit 2 was traveling South on Union Ave NE and approaching the
intersection of NE 4th St and Union Ave NE. Unit 2 was traveling down the right side of stopped
traffic to make a right turn to travel west onto NE 4th St. Upon approaching the back of Firestone
parking Unit 1 pulled into Unit 2's lane where they collided.
Unit 1 stated that he did not see Unit 2 when he was turning.
Both drivers stated they had no injuries on scene, both declined medical treatment by fire.
Mukremin was cited with Inattentive driving.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 01-08-24 07:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 1/1112024 6:21:07 AM
BADGE OR ID# 1Y808 OR]# WA0171300 TIME POLICE DISPATCHED 4:87 PM TIME POLICE ARRIVED]5:02 PM
PART I PAGE IT]OF
REPORT NO. EE39317 CASE# ' 24-265 DATE AND TIME 01/08/24 16:52
OF COLLISION
nit 1
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