HomeMy WebLinkAbout24-7732 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-7732 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 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# ❑ cowsloN 07 - 1-- 2024 0731 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 43RD ST BLOCK NO. e✓ 100 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 400 00 FMILES EET e S ❑ E e EAST VALLEYRD 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2065664239 0 11 30 6� LAST NAME SKACHKO FIRSTNAME TETIANA MIDDLE 1 2 31 INITIAL STREET ❑✓ 14300 SE 171 ST WAY J9 CITY RENTON ST WA 21p 98058 z= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10 9❑ P1 aT�S� CKS7073 sTArI WAvIN# JM16M1 U7XE1122831 TRAILER STATE TRAILED STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >;. FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 3 2014 MAZE) 323 4D DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO STATE FARM 550 1698-E20.47A IN EFFECT z &POLICY# STOP 15 LE vEGALLv HICLe 1 5 36 re5�No D CITATION# 4A0559434 CHARGE IMPROPER LANE USAGE I o aorrom ❑ STANDING 8 6 MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2064327693 16 a LAST NAME MOHAMED FIRST NAME ZAMZAM MIDDLE INITIAL 17❑ STREET , 214065 2ND WAYS CITY' KENT ST WA ZIP 98032 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t l NO 19 LICENSE# STATE WA SEX F M .C... 03 _ 05 _ 1975 39 HELMET I INJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CLD6632 TAre WA VIN# JTMABACA9PA039750 ❑ 41 PLATE# 42 22❑ PLATE# STATE TILER PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2023 MAKE TOYT MODEL BX4X STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO ABDI HAID 2140652ND WAY S KENT WA 98032 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO GEIC04178-79-88-33IN IUQI 'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF08328 COLLISION REPORT III III III III III 111 1591972 CASE# 24-7732 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' Unit 1 eastbound in lane 1, 100 block of S 43rd St. Unit 2 eastbound in lane 2, 100 block of S 43rd St. Unit 1 moved into lane 2, striking unit 2. Driver 1 Skachko told Officer VanderHoek that she attempted to change lanes, looked right and did not see any traffic, then moved right and ran into unit 2. Driver 2 Mohamed told me that she was travelling eastbound when unit 1 suddenly moved right and hit unit 2. Skachko cited via complaint for improper lane usage. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 07-23-24 11:02 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 1 8/25/2024 1:29:53 PM BADGE OR ID# ( 5738 OR]# WA0171300 TIME POLICE DISPATCHED; 7:33 AM TIME POLICE ARRIVED';7:39 AM FART I PAGE IT]OF 3� REPORT NO. EF08328 CASE# 24-7732 DATE AND TIME 07/23/24 07:31 OF COLLISION 1 3 l� t i, rlr I Y r r w w t aa' - � rr a �,� a. M�d�bF�+� Ga�\r\���>• ��: ,, ,.3,r Yam, t�� tt air a �� `�,c t3urtir{t v rya s gfrwi �a �aw tiv ^;z,, s wa a. .a ��;;,...� ...� *..., � ,, „.,".. tr„`ati��"r.��� \ ��; Y, �i����1`•t\a �ti ��t'�rfi, 4 k i V y IF^�CSSI�Sd�kn�5`1ti , Y Y 3 aa� � t 4 ti iSS's'a'; �@ft PAGE 3 OF 3