HomeMy WebLinkAbout24-966 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 24-966 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 1838 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 5 29
UNIT MOTOR
VEHICL Z CYCLE ElOYESA✓NOESHOLD MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 9 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI vrN#'
10[ PI ATE#
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR 3 3. TRLR 33
12 3 5 vIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 4 DODO UNKNO UT DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VewcLe CHARGE 1 5 36
LEC'C YES❑NO❑ CITATION# U
0 BOTTOM
15❑ STANDING 7
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065937590
16 a
LAST NAME MELENCIUK FIRST NAME SAMUEL MIDDLE
INITIAL
17❑ NEW STREETR 11317 S
7 E 179TH ST CITY' RENTON ST WA ZIP 98055 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-S1ENT MEDICAL t—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YES It I NoF t l YES NO
19 LDI IVE STATE WA SEX M M D.C.B. 10 _ 05 _ 1996 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CBK8965 TATE WA vIN 41
# JM3KFBBM7N1523866 1
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
TOWED eY Gov HI 44
VEH YEAR 2022 MAKE IlggZp MODEL CX-5 STYLE UT DAMAGE TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 972081709IN IUQ,
VEHICLE ❑ C[:] CITATION# CHARGELEGALLY YES N25
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
MIN FLICK 12825 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE47399
COLLISION REPORT III III III III III 111
1591972 CASE# 24-966
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,FIRS 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'
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.
BENJAMIN FLICK 01-26-24 08:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 21512024 6:53:19 AM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED: 6:38 PM TIME POLICE ARRIVED',6:51 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE47399 CASE# 24-966 OF COLLISION
01/26/24 18:38
OF CbLLI510N
NARRATIVE
24-966
On 01-26-2024 at approximately 1838 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a hit and run motor vehicle in
the 900 block of SE Carr RD.
Upon arrival I made contact with the victim and victim vehicle. The involved units were identified as
follows:
Unit 1 (Unknown plate) Unknown driver. A possibly copper or tan colored Dodge SUV.
Unit 2 (WA/CBK8965) driver Samuel Melenciuk (DOB: 10-05-1996 via WADL)
Unit 02 was driving Westbound in the left lane on SE Carr Rd. Unit 01 was driving the same direction
(Westbound) in the right lane. Unit 01 was ahead of unit 02 when unit 01 then made an illegal U-turn
from the right lane. Unit 02 tried to avoid the collision by swerving, but was unable to despite the good
attempt. Unit 02 struck the driver side rear bumper of unit 01. Unit 01 then fled the scene eastbound.
I was able to view the collision via the dash camera that unit 02 had. It was clear that unit 01 had
caused the collision by making an illegal U-turn. The license plate was not readable in the video.
Victim Melenciuk had not seen the driver.
Unit 02 had significant damage to the driver side front quarter panel.
I provided victim Melenciuk with a business card and case number.
I observed that the damage to the vehicle was consistent with what Melenciuk had told me and
shown me on the dash camera.
The suspect vehicle was not located.
I provided a citizen upload link to victim Melenciuk via Axon Capture for him to upload the video of the
collision.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 01-26-2024 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE47399 CASE# 24-966 DATE AND TIME 01/26/2418:38
OF COLLISION
not to scale
900 block SE Carr R,D
Unit Oz.
Unit 01
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