Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-4929 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-492s 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION'. 05 - 08 - 2024 0830 17 . N E IN� S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e RAINIER AVE NORTH
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2063353653 0 7 30
6� LAST NAME CHEN FIRSTNAME YU MIDDLE P 1 2 31
INITIAL
STREET ❑ 6711 29TH AVE S CITY SEATTLE ST WA ZIP 981083791 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/INTERLOCK YES[:]NO INTERLOCKYEs �NO / YES 0 NOZ
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 ATE 14 3282FZ STATE WA VIN# 2T2GK31U07C003097
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2007 LEXS RX 350 SV DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO SAFECO H2401165
IN EFFECT &POLICY# 9TOP
VEH" 5 36
LEGALLY YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:4254424325
16 a
LAST NAME KARAZHOV FIRST NAME IVAN MIDDLE
INITIAL
ET
17 STRE❑ NEW ADDRESS❑' 25402 166TH AVE SE CITY COVINGTON ST Wq ZIP 980425243 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[—] LDI IVEW # STATE WA SEX M M .C... 11 25 _ 1995 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# C23566Z TATE 41
WA vIN1i 1C6SRFHM6MN822553 1
42
22❑ TRAILER 3200RB STATE WA TRAILER STATE
PLATE# PLATE#
43
23❑ -LIl 184BU1212KCO28293 IN#
VEH YEAR 2021 MAKE RAM MODEL 1500 STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO IVAN KARAZHOV 25402 166TH AVE SE COVINGTON WA 98042 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#ECO STATE FARM 5255769-DO5-47-001 1 9TOP 5
IN EFFECT
'E""LE CITATION# CHARGE
LEG i o BOTTOM
ALLY YES N� 6
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE75530
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4929
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
PM 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'
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.
MATTHEW NUGENT 05-08-24 06:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 51912024 2:05:26 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 10:54 AM TIME POLICE ARRIVED',11:02 AM
PART I PAGE IT]OF
REPORT NO. EE75530 CASE# 24-4929 OF COLLISION
05/08/24 08:30
OF CbLLI510N
NARRATIVE
24-4929
On 05/08/2024 at approximately 1054 hours, I was dispatched to a non-injury and blocking vehicle
collision at the intersection of Rainier Avenue North and Airport Way, within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised that the collision occurred at the intersection around 0830 hours
and involved a black Dodge truck, a grey Lexus RX350, and a white Nissan sedan.
Upon my arrival, I confirmed there were no complaints of injury at the time of report. There, I collected
the involved parties driving documents and their independent summary of the collision.
The driver of Unit#1 stated that she was the sole occupant of her vehicle and was traveling
westbound on Airport Way approaching the intersection of Rainier Ave North in lane 1 of 4. The driver
of Unit#1 stated that she was intending to continue west. The driver of Unit#1 stated that upon
approaching the intersection, she observed Unit#2 stopped and waiting. The driver of Unit#1 said
that there was a green light for her direction of travel and was unsure why traffic was stopped. The
driver of Unit#1 attempted to pass Unit#2 to proceed forward but subsequently collided with the front
driver's side door, fender, and mirror of Unit#2. Unit#1 suffered minor damage to the rear passenger
side door and fender. Due to the impact between Unit#1 and Unit#2, Unit#3 was also struck
causing additional damage to the rear driver's side fender of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and was also traveling westbound
on Airport Way approaching the intersection of Rainier Ave North in lane 1 of 4. The driver of Unit#2
stated he was intending to make a northbound turn onto Rainier Ave North but had stopped for
queued traffic. The driver of Unit#2 stated that while stopped, Unit#1 attempted to pass his vehicle
but must have miscalculated how much room they had and subsequently collided with the driver's
side door, fender, and mirror. Unit#2 suffered moderate damage to his vehicle and could not open
the front driver's side door following the collision.
The driver of Unit#3 said he was the sole occupant of his vehicle and was also traveling westbound
on Airport Way approaching the intersection of Rainier Ave North but in lane 2 of 4. The driver of Unit
#3 stated he was intending to continue westbound on Airport Way and across Rainier Ave North but
had stopped for queued traffic. The driver of Unit#3 stated that while stopped, Unit#1 attempted to
pass his vehicle and must have miscalculated how much room they had and subsequently collided
with the passenger side door and fender.
No witnesses were immediately available at the scene. Upon checking to see if there was an
available traffic camera at this location, it was determined that there is not a traffic camera and
footage was not obtained.
Based on the above statements, I determined that the driver of Unit#1 (Chen) was the predominant
factor for the cause of collision. The driver of Unit#1 violated RCW 46.61.140 as any vehicle shall be
driven as nearly as practicable entirely within a single lane and shall not be moved from such lane
until the driver has first ascertained that such movement can be made with safety.
All involved vehicles were able to be driven away without further incident. An exchange of information
was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
PAGE 3 OF 6
REPORT NO. EE75530 CASE# 24-4929 OF COLLISION
05/08/24 08:30
OF CbLLI510N
NARRATIVE
Electronically signed by Officer M. Nugent#11498 6:19 PM 5/8/2024 Renton, King County, WA.
PAGE 4 OF 6
SUPPLEMENTAL REPORT NO. EE7555530
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-4929
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES NO
D:2062406038
OF 7 29
LAST NAME HUNTER FIRST NAME BRUCE MIDDLE'.. W
INITIAL
STREET r:i 30
NEW AnDRFSP' 10424 60TH AVE S CITY SEATTLE ST WA ZIP 98178
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 08 - 04 - 1972
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE AAD1456 [TAT WA VIN# JN1CA31D4YT744016
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 3 5 VEH.YEAR2000 MAKE NISS I MODELMAXIMA STYLE 4D VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1I' P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER J 9 33
12 � SHADE IN DAMAGED AREA
7 FROM TO
LIABILITY INSURANCE❑ INSURANCE CO STATE FARM 1397038-816.47
IN EFFECT &POLICY# 1 4 TCSP S
LEGA LE 34
13 ❑ LEGALLY YES NO❑ CITATION# CHARGE 0 0Q Y)M
STANDING �} 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F1' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAr VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeGALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MATTHEW NUGENT 05-08-24 06:40 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 11498 O#IL WA0171300 JOHNSON 51912024 PAGE F OF 6
3000-345-013(R 11118)
REPORT NO. EE75530 CASE# 24-4929 DATE AND TIME 05/08/24 08:30
OF COLLISION
k
y �
k
e
PAGE 6 OF 6