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HomeMy WebLinkAbout24-5788 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-s788 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION'. 06 — 01 — 2024 1052 17 ❑.❑ S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE PETROVITSKY RD BLOCK NO. e✓ 10800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 FEET MILES e S ❑ W e 108THAVESE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2067191724 0 11 30 6� LAST NAME CARABAS FIRSTNAME DORA MIDDLE 1 2 31 INITIAL STREET ❑, 10825 SE 200TH ST B202 CITY KENT ST WA ZIP 980310000 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ ORIILICENSE# STATE yyq SEX'F MIDI Y' 03 — 01 — 1953 1 1 2 32 9 ON DUTY❑ STATUS' AIRBAG 4 RESTR 9 EJECT 1 H U SE CLASS 7 SORE NECKAND BACK z❑ 3 10 9❑ P1 ATE 14 Af20217 STATE WA VIN# 4T18E30K85U583345 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE 1# FROM To TRLR. TRLR $ 7 33 12 3 5 VIN#' VIN# >;. FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34 13 2 ZOOS TOYT CAMRY 4D DAMAGE vEs No �LAWYkkR'S TOWING YES NO REGISTERED OWNER INFO DORA CARABAS 10825 SE 200TH ST APT B202 KENT WA 98031 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 3 4 2 14 LIABILITY INSURANCE INSURANCE CO THE CINCINNATI INSURANCE COMPANYA01 N58534 IN EFFECT &POLICY# 9TOP VE"'CLE CHARGE 5 36 LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA. YES 1/ NO D:2069105218 16 a LAST NAME LINGAT FIRST NAME RAFFY MIDDLE A INITIAL 17 STREET I❑ s❑' 6415 S 127TH PL CITY' SEATTLE ST WA ZIP 981783634 4❑ 37 NEW ADOREs 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑ 19 LICENSE# STATE WA SEX M M D.C.B. 09 _ 01 1992 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT ''1 USE CLASS ❑ LICENSE ❑21❑ PLA E# CBW6691 TATe 41 WA vIN# JA4J4VA82NZ039261 1 42 22❑ PLATE# STATE PLATE ILER# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2022 MAKE MITS MODEL OUTLAN STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24 DAMAGE YES�/ NO BANKER'S TOWING YES NO REGISTERED OWNER INFO RAFFYLINGAT6415S127THPL SEATTLEWA98178 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE I PORGY#ECO PROGRESSIVE INSURANCE 955649536 STOP 5 IN EFFECT VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N J 6 25 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. EE82782 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5788 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,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' The driver of vehicle #2 provided the following account: Vehicle #1 was facing north, turning left out of a parking lot on the south side of the road in the 10800 block of SE Petrovitsky Rd. Vehicle #2 was traveling eastbound in the outside lane of the 10800 block of SE Petrovitsky Rd. As vehicle #1 turned left out of the parking lot onto SE Petrovitsky Rd, the rear left corner of vehicle #1 collided with the front end of vehicle #2. This caused vehicle #1 to spin counter-clockwise and slide against the driver's side of vehicle #2. The driver of vehicle #1 provided the following account: Vehicle #1 was traveling westbound on SE Petrovitsky Rd and the driver of vehicle #2 was driving eastbound "way too fast", though she did not give any further explanation as to what caused the collision. Based on the totality of the circumstances, it appears vehicle #1 was the proximate cause of the 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 06-01-24 03:01 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 1 6/2/2024 3:39:08 PM BADGE OR ID# 11631 ORI# ( WA0171300 TIME POLICE DISPATCHED! 10:53 AM TIME POLICE ARRIVED 10:58 AM FART I PAGE IT]OF 3� REPORT NO. EE82782 CASE# 24-5788 DATE AND TIME 06/01/2410:52 OF COLLISION r' �5 I , Vesicle PAGE 3 OF 3