HomeMy WebLinkAbout24-5910 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EE85812OLCERA
COLLISION REPORT 1591971
CASE�# 24-5910 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL CO A`NG 4200 3[--�
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 04 - 2024 1006 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
SW GRADY WAY
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ C------�. FEET e S 8 W e LIND AVE SW
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:2068509664 0 8 30
5 LAST NAME MAYER FIRST NAME BRANDON MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 805 TOLE LAKE RD S CITY TACOMA ST WA ZIP 984443503 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCkvEs Na YEs NOFJ
8❑ LICENSE# STATE WA SEX'M MMOCSYY' 04 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CJU5178 STATE WA VN# 1C3CDZAB7CN231141 3
10[9� PI ATF#
11[-j- TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
TRLR TRLR 7 3 33
12 0 0 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 9 9 34
13 2 2012 DODG AVENGE DAMAGE Yes�No ✓� Yes❑ No�
REGISTERED OWNER INFO BRANDON MAYER 805 TULE LAKE RD S TACOMA WA 984443503 D:2068509664 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
14❑ El
NSURANCE CO 3 4
LIABILITY INSURANCE ❑
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE 70 BOTTOM 5 36
15
s ALLYc yes❑NO❑ CITATION# 4A0361513,4A0361513 INATTENTIVE DRIVING,OP MOT VEH 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM TO OLD MET PHONE
UNIT VEHICLE CYCLE' ❑ ❑ nWNFR YEs�/ No D:4253262345
16�
LAST NAME POPLAVSKYI FIRST NAME MAKSYM MIDDLE N
INITIAL
17 STREET'❑ ❑3528 138TH PL SW CITY LYNNWOOD ST, W 37
q ZIP 980875211
NEW AbbRESS
1 g❑ CDL IGNITION REQUIRED IGNTION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYEs NO INTERLOCK YES Nt YEs NO
19� DRIVER'S STATE WA SEX M I D.O.B. 05 14 1983 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CLY6663 TATE WA VIN# WD3PE7CD5JP631997 � 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 201$ MAKE MERZ MODEL SPR/NTE STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO MAKSYMPOPLAVSKY73528138TNPLSW L..ODWA980875211 D:4253262345 VEHICLE NO.2
SHADE IN DAMAGE$AREA
2 3 �4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 971391987
IN EFFECT &POLICY# I 9TOP
veeicLe ,J—I CITATION# CHARGE tO BOTTOM
Lecntty YES N`[
25 s 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EE85812
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5910
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.
M.LEVERTON 06-04-24 11:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 611012024 6:51:34 AM
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 10:10 AM TIME POLICE ARRIVED 10:19 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EE85812 CASE# 24-5910 O COLLI COLLISION TIME
OF 06/04/24 10:06
COLLI
NARRATIVE
lane 2 lind eb rear blue van gray sedan
CC
Within the city limits of Renton/King/WA I responded to a 2 car non blocking crash at Lind Ave SW at
SW Grady Way.
I contacted the driver of unit 2 who told me he was stopped EB on SW Grady at Lind Ave SW when
he was hit from behind by unit 1. He did not complain of injury and damages did not require a tow
truck. The crash did knock his rear bumper/metal step clear off his vehicle.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he just didnt get stopped in time
even though unit 2 was clearly stopped. I asked unit 1 if he had good tires/brakes and he said yes.
Was just human error. He did not complain of injury and damages did not require a tow truck. He
told me he did not have valid proof of insurance of his vehicle or had a policy from a previous vehicle.
I cited unit 1 Mayer ref RCW 46.30.020 No Insurance and Ref RMC 10-12-25 Driver Inattention via
complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 6/4/2024
PAGE 3 OF 4
REPORT NO. EE85812 CASE# 24-5910 DATE AND TIME i 06/04/24 10:06
OF COLLISION
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