HomeMy WebLinkAbout24-4427 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-4427 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 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 04 - 1-- 2024 1603 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e UNION AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063038653 0 81
30
6� LAST NAME PICKETT FIRSTNAME LUCAS MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 650 DUCALL AVE NE APT G724 CITY RENTON ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C00133H sTArI WAurN# NMOLS7E72G1282697
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#'
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T�,��(pNg GOVT.VEHICLE 9 9 34
13 4 2016 FORD TRANSI CG DAMAGE YES NO ""�WN 'Es❑ NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� LIABILI INSURANCE INSURANCE CO ACE AMERICAN INSURANCE ISAH25563165 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
LECALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2533108041
16 a
LAST NAME YELISEYEV FIRST NAME KIRILL MIDDLE O
INITIAL
17 STREET❑ NEW ADOREss❑' 12266 155TH AVE SE CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK yEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA SEX M M D.C.B. 08 _ 19 _ 1992 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ ILICENSE PLATE# 62DIKT TArE FL VIN# 2T3F1RFV7MW185454 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
Gov HI
VEH YEAR 2021 MAKE 7'Dy7- MODEL RA V4 Dfj
44
STYLE UT AMAGE TOWED NOO✓ BLIN TOWED BY YES
NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY 41057-56477-90 1 STOP
IN EFFECT
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES NC�
25❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE71522
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4427
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'
I was dispatched to a collision on 04/23/24 at 1607 hours at Shell station at 4102 NE 4th St, in city
Renton, King County WA.
Unit 1 C00133H Driver: Lucas C. Pickett (DOB 09/18/1980)
Unit 2 62DIKT Driver: Kirill O. Yeliseyev (08/19/1992)
Unit 2 was sitting at the stop light at the intersection of NE 4th St and Union Ave NE facing East when
he was struck from behind. Unit 2 stated he was the 3 or 4th person back from the light. He did not
see Unit 1 coming and just felt the hit from behind. Unit 1 was traveling East on NE 4th St and
approaching the intersection of NE 4th St and Union Ave NE he stated Unit 2 came to a quick stop.
Unit 1 stated he did not have enough time to stop and swerved to the left causing him to collide with
Unit 2.
Both drivers stated no injuries and only Unit 1 needed a tow which was provided by his company.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 04-24-24 03:28 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 4/25/2024 8:19:25 PM
BADGE OR ID# 12808 OR]#' > WA0171300 TIME POLICE DISPATCHED 4:07 PM TIME POLICE ARRIVED 4:13 PM
PART I PAGE IT]OF 3�
REPORT NO. EE71522 CASE# ' 24-4427 DATE AND TIME 04/23/24 16:03
OF COLLISION
I
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