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HomeMy WebLinkAbout24-13132 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c COLLISION REP FIT 1591971 CASE 24-13132 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#TRIBAL OF 03 OBJECT 1 1 8 28 UNITS RESERVATION I STRUCK z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# GowsloN 12 - 1-- 2024 1438 17 =.= S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ 116TH AVE SE BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ MILES�.❑ FEET e S B W e SE 177TH PL OF,1 29 MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE UNITS VEHICLE ❑ CYCLE ❑ YEs �/No D:2533267335 0 7 30 6 LAST NAME GOROKHOVSKIY FIRSTNAME VITALIY MIDDLE P 1 1 2 31 INITIAL STREET 0121659SE270THST CITY MAPLE VALLEY ST WA 21p 980386113 z= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID ELOB 03 - 17 - 1995 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10 9❑ P1 ATNFS14 CCN8794 STATE WA u N# JF2SJABC9HH501714 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM ro TRLR. TRLR. 5 1 33 12 0 0 VIN#' VIN# :: FROM TO ❑ VEH.YEAR MAKE SUBA MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34 13 2 2017 FOREST DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO VITALIY GOROKHOVSKIY 21659 SE 270TH ST MAPLE VALLEY WA 980386113 D:2533267335 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14rI LIABILITY INSURANCE INSURANCE CO ALLSTATE 987 367420 <1�3 4 IN EFFECT &POLICY# TOPvEHICLE CHARGE 36 LE ALLY re5 No clTAnoN# 4A0765750 INATTENTIVE DRIVING orroM 15❑ STANDING 7 6 MOTOR PEDAL- : PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE Z CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES�/ NO D:2068560609 16 a LAST NAME NHEM FIRST NAME CHUA MIDDLE I S INITIAL 17❑ STREET ❑', 16802 113TH LN SE CITY' RENTON ST WA ZIP 980556505 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 D IVEW # INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CET2393 TATE WA VIN# JTEBU5JR9D5132332 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2013 MAKE TOYT MODEL 4RUNNER STYLE VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO CHUA NHEM 16802113TH LN SE RENTON WA 980556505 D:2068560609 VEHICLE NO.2 SHADEd DAMAGE$�dAREA 4� 3 LIABILITY INSURANCE 8 POINSURGY#E CO ALLSTATE 564 633 632IN STOP VE""LE CITATION# CHARGE YES 25 N to BOTTOM LEGALLY u ❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF51434 COLLISION REPORT III III III III III 111 1591972 CASE# 24-13132 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 PM 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' 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 12-24-24 03:25 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 12/30/2024 10:51:58 AM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 2:38 Pry TIME POLICE ARRIVED',2:47 PM PART B PAGE IT]OF 5� REPORT NO. EF51434 CASE# 24-13132 FC LNaoy L isI©�ON O 12/24/24 14:38 F cu NARRATIVE blk/3 wht/2 blu/1 stopped for car making left turn 1 rear CC Within the city limits of Renton/King/WA I responded to a 3 car crash near the intersection of 116th Ave SE at SE 177th PL. I contacted the driver of unit 3 who said he was stopped northbound for a car making a left turn when unit 1 hit unit 2 making unit 2 hit him. He complained of a headache. Renton Fire checked and released him on scene. Damages did not require a tow truck. I contacted the driver of unit 2 who told me she was stopped behind unit 3 while waiting for a car to make a left turn when she was hit from behind by unit 1. It shoved her forward into unit 3. She did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 1 ID'd by picture WADL. He told me he believed someone was making a left turn illegally and he was unable to stop in time for stopped traffic, hitting unit 2. He had heavy front end damage that needed a tow truck but he made his own arraignments to have the car hauled off. He did not complain of injury. This section of the road had good visibility, level and straight. Both unit 2 and 3 were stopped with no issues with or raised issue with the other car making a left turn. I believe unit 1 was either going too fast or not paying attention to traffic stopped in front of him. I cited unit 1 ref RMC Driver Inattention 3 car crash 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 12/24/2024 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EF51434 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-13132 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70T !CC# VEHICLE TYPE CARGO BODY TYPE ❑ 1 28 2 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 ✓ PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:2068582121 0 7 29 LAST NAME SADIKI FIRST NAME RAMIZ MIDDLE' R INITIAL STREET 30 NEW AnDRFSP' 18838 124TH AVE SE CITY RENTON ST WA ZIP 980587211 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 07 - 15 - 1973 7 HELIJIET :INJURY' NATURE OF INJURIES ON DUTY STATUS AIRBAG'' 7USE CLASS HEADACHE 8 ❑ 1 32 LICENSE CBX1798 TAr WA VIN# 3FMTK1RM7MMA55336 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2021 MAKE FORD MODELMUSTAN STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1I' FROM TO DAMAGE YES NO ✓ YES NO ✓ REGISTERED OWNER INFORAMIZ SADIKI 18838124TH AVE SE RENTON WA 980587211 g g 33 12 � SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE INSURANCE CO ST FARM 495.8960-A 13.47D q"i"Olx IN EFFECT &POLICY# 1 ________ S VEHICLE ( 34 13 2 ecnuv YES NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 V 14 ❑ UNIT Tr Vd I RE O CYDCLE � OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 35 15 LAST NAME FIRST NAME INITIALAL MDDLE ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES NO NTERLOCK YES NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE ICLASS 19 ❑ 39 LICENSE rnr vIN# PLATE# 20 ❑ TRAILER TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 a 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P _ 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv STANDING S 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 12-24-24 03:25 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 25 ORID# 2517 O#11,WA0171300 JACOBS 12130/202 PAGE 4 OFF 3000-345-013 IR 11t18) REPORT NO. EF51434 CASE# 24-13132 DATE AND TIME 12/24/2414:38 OF COLLISION 3 1 r l e C. 9 y� { 1 i i qt t� r e �cr � TM 1 ,a x ; ` t Ut e x t" ti n: PAGE 5 OF 5