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HomeMy WebLinkAbout24-8895 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF09964 170
27
COLLISION REP FIT 1591971
CASE 24-8895 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HIT& F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION OS - 1-— 2024 1613 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
OAKESDALE AVE S
e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW41ST ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2064121977 0 11
30
6❑ LAST NAME ARKHIPCHUK FIRSTNAME VITALIY MIDDLE S 1 2 31
INITIAL
STREET ❑, 1210 M ST SE APT 6 CITY AUBURN ST WA ZIP 98002 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 06 1— 12 — 1974 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CLM7858 sTArI WAVIN# JTDKB20U773276850
10 F91 PI ATE#
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. YRLR. 3 5 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2007 TOYT PRIUS SD DAMAGE vEs 0NO f �AWkkRS TOWING vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑
14 LIABILITY INSURANCE Z INSURANCE CO PEMCO CA0813295 35
IN EFFECT &POLICY# �1'OP
VEwcLE CHARGE ❑ 36
LEGALLY YFS❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063723172
16 a
LAST NAME GARCIA CORTES FIRST NAME JUAN-CARLOS MIDDLE
INITIAL
17 STREET NEW ADOREss❑' 907 JERICHO PL NE CITY' RENTON ST WA ZIP 98059 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO INTERLOCK vEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE WA SEX M D.O.B. 05 _ 02 _ 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# B2909 41
0U TArE WA VIN# 1FTSS34L75H846087 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
%
'I
TOWED By Gov HI 44
VEH YEAR 2005 MAKE FORD MODEL ECONOLI STYLE VN —TEHICLE
TOWED✓ NOO BLIN BANKERS TOWING YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE I PORGY#ECO PABON INSURANCE AGENCY CB002390202 STOP 5
IN EFFECT
VE""LE ❑ Nu,J CITATION# CHARGE
LEGAL to BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.EDMUNDS 12576 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF09964
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8895
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) REYES NICOLE
(LAST FIRST,
ADDRESS&PHONE#
2064884588 SEX' F MMDDYYYY -❑
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) DINH MITZI
ADDRESS&PHONE# D O E4
4257851207 SEX IF MMDDvvYv
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was stopped on SW 41st ST at a stop sign, waiting to make a left turn onto Oakesdale Ave
SW. Unit#2 was traveling northbound on Oakesdale Ave SW. Unit 1 attempted to make the left turn,
entering Oakesdale Ave SW and misjudging the speed of oncoming traffic. Unit#2 struck Unit#1 as it
was crossing the lane of travel causing damage to both vehicles. The improper left turn of Unit#1
was the proximate cause of the collision.
Both driver's provided WA DL and current insurance. Banker's towing responded to the scene and
removed both vehicle. I provided an exchange of information to both drivers for documentation.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by E. Edmunds/#12576 at 1906 hours on 08/23/2024, in the City of Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.EDMUNDS 08-23-24 08:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 8/30/2024 12:29:46 AM
BADGE OR ID# 12576 OR]# WA0171300 TIME POLICE DISPATCHED 4:13 PM TIME POLICE ARRIVED',4:13 PM
PART I PAGE IT]OF 3�
REPORT NO. EF09964 CASE# ' 24-8895 DATE AND TIME 08/23/24 16:13
OF COLLISION
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