HomeMy WebLinkAbout24-1719 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-1719 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. 02 - 1-- 2024 1847 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
MONROEAVENE M700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ We NE7THST
OF1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252130903 0 11
30
6� LAST NAME VASILEVA FIRSTNAME ZLATKA MIDDLE P 1 1 2 31
INITIAL
STREET ❑ 3926 NE 4TH CIR CITY RENTON ST WA 21p 980568552 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEXI F MM DAY' 06 1— 26 — 1962 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 2❑ I P1 ATES# BXU2510 sTAr WAu N# 5J6RM4H32Et 117029
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 3 7 34
13 4 2014 HOND CR-V SE P4 DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO ZLATKA VASILEVA 3926 NE 4TH CIR RENTON WA 980568552 D:4252130903 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 ABILI INSURANCE ESURANCE INSURANCE COMPANY PAWA-005298971
IN EFFECT &POLICY#
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER [:]EA.
YES 1/ NO D:2063873310
16 a
LAST NAME HOEPER FIRST NAME BENJAMIN MIDDLE IC
INITIAL
17❑ NEW STREETREs7' 12506 SE 99TH ST CITY l RENTON ST WA ZIP 980562422 4❑ 37
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 M D.O.B. O6 _ 17 1998 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# D03983D TArE WA VIN# 3C63R3CoL3NG116498 41
1
42
22❑ PLATE# STATE PLATE# STATE
T
23❑ 43
IN# N RLR
#.UIN#. 'I
VEH YEAR 2022 MAKE RAM MODEL 3500 STYLE 4C VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HOEPER ENTERPRISE LLC 12506 SE 99TH ST RENTON WA 98056 VEHICLE NO.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY INSURANCE INSU&PORGY#E CO BERKSHIRE HATHAWAYHOMESTATE 02 APG 13 73 2 5-01 I STOP 5
IN EFFECT
VEHICLE ❑ C[ CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE51163
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1719
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SELTVEIT RODNEYD
(I.P.ST FIRST,
ADDRESS&PHONE#
3204 NE 7TH ST RENTON WA 98056 2063690707 SEX M MMDDYyry 01 - 23 - 1956
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE of INJURIES
❑✓ POS. USE CLASS +
NAME
'(LASTr FIRS' 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&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 a collision on 02/16/24 at 1848 hours at NE 7th St and Monroe Ave NE in the 700
block, in city Renton, King County WA.
Unit 1 BXU2510 Driver: Zlatka P. Vasileva (DOB 06/26/1962)
Unit 2 D03983D Driver: Benjamin C. Hoeper (06/17/1998)
All drivers were identified by their WADL.
Unit 2 was traviling West on NE 7th St and came to a stop at NE 7th and Monroe Ave NE. Unit 2 then
started through the intersection going West when he was struck on his passenger side by Unit 1. Unit
2 was traveiling South on Monroe Ave NE when she stated she stopped at the stop sign on NE 7th St
and Monroe Ave NE. Unit 1 said she started driving through the intersection heading south on
Monroe Ave NE and did not see where the truck came from. There was a witness that stated he saw
Unit 1 collide into the truck and he stated by the speed she was going he believes that she did not
stop at the stop sign.
Both drivers stated they had no injuries and did not need medical attention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 02-16-24 09:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 2/16/2024 10:48:38 PM
BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 6:48 PM TIME POLICE ARRIVED',6:54 PM
PART Ei PAGE IT]OF
REPORT NO. EE51163 CASE# ' 24-1719 DATE AND TIME 02/16/24 18:47
OF COLLISION
ug
4 1
i lT
5
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