HomeMy WebLinkAbout24-1284 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
24-128a 2
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
C{YLLISION O2 - O5 - 2024 0704 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254990445 0 11
30
6� LAST NAME SHAKERI FIRSTNAME SAHAR MIDDLE N 1 2 31
INITIAL
STREET Z14314NE3RDST CITY RENTON ST WA Zjp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 4 RESTR 9 EJECT 1 H U SE CLASS 6 SORE LEFTARMS z❑
3
10❑ P1 ATE 14 BE22375 STATE WA VIN# JTNKARJEOHJ537747
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE
T COROL HBEHICLETOWED TO BLIN I TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2017 TOYT COROL HB DAMAGE YES fn TO YES[:] H
REGISTERED OWNER INFO SAHARSHAKERI 4314 NE 3RD ST RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 929493858 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDIN 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2063963165
LAST NAME KARABAN FIRST NAME KATERYNA MIDDLE N
INITIAL
17 STREET I❑ 19844 142ND AVE SE CITY' RENTON ST WA ZIP 980589444 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LDIIVE STATE WA ]SEX IF M .O.B. 03 _ 26 _ 1991 39
WELMET INJURY6 NATURE OF INJURIES 40
20� ON DUTY[:I] STATUS AIRBAG,3 RESTR 9 EJECT 1 USE CLASS CUT ON RIGHT HAND
❑LICENSE I 21❑ PLA E# CGL6509 TATe 41
WA vIN# 1FADP3K28GL271304 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE FORD MODEL FOCUS STYLE HB VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO BANKERS TOWING VEHICLE
NO
REGISTERED OWNER INFO KATERYNAKARABAN19844142NDAVESE RENTONWA98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO SAFECO INSURANCE H2426023IN 5VEHICLE ❑ ,.IICITATION# CHARGE25 C�Q
LEGALLY YES N`LJ
s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE47704
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1284
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
Vehicle #1 was traveling eastbound on NE 4th St approaching Duvall Ave NE. Vehicle #2 was
traveling westbound on NE 4th St approaching Duvall Ave NE. As vehicle #1 turned left onto Duvall
Ave NE, the front end of vehicle #2 collided with the right side of vehicle #1. The driver of vehicle #1
advised me she had a yellow left turn arrow when she made the left turn through the intersection.
The driver of vehicle #2 advised me she had a green light to proceed through the intersection. The
driver of vehicle #1 complained of left arm pain, but declined aid. The driver of vehicle #2 had a
scratch on her right hand but declined aid. Based on the totality of the cirucumstances and the
differing stories provided by each driver, I was unable to determine which driver was the proximate
cause of this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 02-05-24 05:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 2/6/2024 4:03:31 AM
BADGE OR ID# 11631 OR]# WA0171300 TIME POLICE DISPATCHED'! 7:07 AM TIME POLICE ARRIVED',7:14 AM
PART I PAGE IT]OF 3�
REPORT NO. EE47704 CASE# 24-1284 DATE AND TIME 02/05/24 07:04
OF COLLISION
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