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HomeMy WebLinkAbout24-6266 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE89709 170
27
COLLISION REP FIT 1591971
SAS 24-6266 2
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# ❑
CtLLISION' 06 - 1-- 2024 1545 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 3100
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2535479597 0 11
30
6❑ LAST NAME VU FIRSTNAME DOYEN MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 6032 S OAKES ST CITY TACOMA ST WA 2jp, z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 02 1- 05 - 2003 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi ATE 14 CGY3991 STATE WA u N# 1 N4BL4BV8MN376959
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEARN MAKE NI$S MODEL ALLIMA STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13❑ DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO TRAVELERS INS.6135425242031 3
IN EFFECT &POLICY# 9TOP
vECeHA"Le 5 36
LIIv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255479597
16 2
LAST NAME BULASH FIRST NAME TARAS MIDDLE
INITIAL
17❑ STREET ❑', 10303 128TH AVE SE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 DRIVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑
21❑ LICENSE I CLF4826 TATE WA VIN# 1VWBN7A32EC005876
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
GI
VEH YEAR 2014 MAKE YOLK MODEL PA$$A 7' STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
VEHICLE YES[:] NCE] CITATION# 4AO515775 CHARGE OP MOT VEH W/OUT INSURANCE 10 BOTTOM
LECA— LJ
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
YUSUF JIBRIL 12490 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE89709
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6266
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'
On 06/14/2024, at approximately 1555 hours, I was dispatched to investigate a collision at 3100 blk of
NE Sunset Blvd, City of Renton, King County, State of Washington.
Upon arrival, both drivers reported that they were not injured and did not need any medical attention.
Vehicle 2 was drivable and vehicle 1 was privately towed.
The driver of unit 1, reported that she was traveling eastbound on NE Sunset Blvd on the turn lane.
Unit 2 was traveling westbound on NE Sunset Blvd on lane 1. The driver of unit 1 said the vehicles
traveling westbound on lane 2 stopped so she proceeded to make left turn to the complex on 3172
NE Sunset Blvd. Driver 1 said Unit 2 who was traveling on Lane 1 collided while she was making the
turn. Driver 1 said Unit 2 was speeding and she did not have time to avoid the collision. Unit 1
sustained damages to the right rear tire and was not drivable.
The driver of Unit 2 said he was traveling westbound on Lane 1. The driver said Unit 1 pulled in front
of him to make a left turn. He said he did not have time to stop due to wetness of the roadway, so he
collided with Unit 1. Unit 2 sustained front end damage. Unit 2 was drivable. Driver of Unit 2 did not
have a valid insurance for his vehicle.
Both drivers were provided with business card and case number. The driver of unit 2, Bulash, Taras
was issued a citation for operating a motor vehicle without an insurance.
I certify under penalty of perjury under the laws of the state Washington that the foregoing is true and
correct.
Y.Jibril/ 12490
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
YUSUF XBR/L 06-19-24 09:41 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 6/24/2024 12:16:10 PM
BADGE OR ID# 12490 ORI# WA0171300 TIME POLICE DISPATCHED; 3:55 PM TIME POLICE ARRIVED',4:04 PM
PART I PAGE IT]OF 3�
REPORT NO. EE89709 CASE# ' 24-6266 DATE AND TIME 06/14/24 15:45
OF COLLISION
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a
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