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HomeMy WebLinkAbout24-12006 �oLcRaiTFFiN 0 5 27c REPORT NO. EF44829 COLLISION REP F 1591971 CASE# 24-12006 2 INTERSTATE CITY STREET FIRE ❑ RESULTED STOLEN 1 2 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4100 3[� HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$ RESERVATION 2 3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY# LOLL s ON 11 - 20 - 2024 0610 17 a. e W 8 OF IN 8 1070 3 S 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE PETROVISTKY RD BLOCK NO. MILEPOST ❑ 8 4a DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1.= FEET e S e W 8 116 AVE SE 0 1 29 MOTOR PEDAL- DAM ETHRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES ,/No D:2537407197 0 1 30 6❑ LAST NAME PETERSON FIRST NAME MYKAL MIDDLE' F 1 2 31 INITIAL STREET Ir I' 11130 SE 208TH ST APT N103 CITY KENT WA NEW ADDRESS S7 ZIP 98031 z 7❑ CDL IGNITION RECtUIRED IGNITION PRESENT MEDICAL-1 NO OftTED 3 INTERLOCKYEs No,/ INTERLOCKYEs NO YES Na,/ 8❑ LDICENS STATE WA SEX'M MM,:B 10 - 20 - 1995 1 2 32 9 ON DUTY STATUE AIRBAG 2 RESTR 9 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES 2 USE CLASS COMPLAINT OF HEAD INJURY LICn NSE BUZ8119 srnre WA VIN# 3FA6POLU5KR202667 10 9❑ 3 11 0 0 PLATE# STATE TRAIPLATE# STATE ROM To TRLR TRLR. 1 5 33 12 O O VIN#' VIN# : FROM TO 13 4 VEH.YEAR2019 MAKE FORD MODEL FUSION STYLE SD VEHICLE TOWED 2NOni�ABLIN IDNED.4LR$�OW GOVT,VEHIICL✓ ] $ 34 ❑ DAMAGE II1I._IIII tlAlVt(t ccJllu—'II REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1 SHADE 1N DAMAGED AREA ❑ 35 4 LIABILITY INSURANCE INSURANCE CO 3 4 14 STATE FARM 471 3459-F25.47A IN EFFECT &POLICY# STOP VtwCLt YES CHARGE 5 ❑ 36 EGALl v ❑NO❑ CITATION# 10 ftOTTOM 15❑ YT—N. 6 MOTOR PEDAL: PROPERTY DAM THR OLD MET PHONE UNIT PEDESTRIAN ❑ HO 3607229171 VEHICLE CYCLE OWNER YES NO 16� LAST NAME HARDMAN FIRST NAME JERALD MIDDLE T INITIAL 17 STREET Z 2813 J CT SE STE A CITY AUBURN ST', WA ZIP 98002 37 NEW ADDRESS I I I ❑ 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDfCALTRANSPORTED ❑ 38 iNTERLOCKYrs NO INTERLOCK Es N-✓ YES No,/ 19 DRIVER'LICENSE# STATE WA SEX M MMDDYvlN 03 09 1962 39 FNATURE OF INJURIES 20 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEE7 CLASY' 7 SCRATCH TO HIS KNEE 40 21❑ LICENSE I CNR9330 TArE,WA vIN# JTNKHMBX8M1096295 ❑ 41 PLATE# TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42 23 43 TRLR RLR VIN#. '[N#, VEH.YEAR 2021 MAKE TDYT MODEL C-HR STYLE $D DAMIAGE TOWED✓ ND BLIN TOWED BY GO yES N HI 44 YESO 24 REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2 SHAD DAMAGED AREA LIABILITY INSURANCE INSURANCE CO USAA MS.00418 81 44 G 3 4 IN EFFECT &POLICY# 4TOP - 5 venue ❑ .1-1 CITATION# tO eOTTQM �Ecn��v YES N CHARGE 25 J s e OFFICER'S NAME(PRINT) 26 OFFICER PHONE BADGE OR ID# JAGENCY YUSUF JIBRIL 12490 WA0171300 PART A . PAGE 01 OF 9000-345-159(R 11(181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF44829 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12006 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) CHAN DANIELLE L ADDRESS&PHONE AUBURN 3607229171 SEXi F MMDD'yyYv 07 - 27 - 2000 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES z ❑ 2 POS. 3 3 4 1 USE GLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ PC& I 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. YUSUF XBRIL 11-20-24 07:58 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1211112024 2:42:15 PM BADGE OR ID# 12490 ORI# WA0171300 TIME POLICE DISPATCHED 6:14 AM TIME POLICE ARRIVED i 6:15 AM PART B 3000-345.160(R1Vt8) PAGE F2 --]OF 47 REPORT NO. EF44829 CASE# 24-12006 OFCOLLI ION 11/20/24 06:10 OF COLLISION NARRATIVE On 11/20/2024, at approximately 0615 hours, I was dispatched to investigate an injury collision 116 Ave SE/ SE Petrovitsky RD, City of Renton, King County, State of Washington. Upon arrival, I observed that unit 2 had severe front-end damage and the front airbags were deployed. Driver of unit 2 was complaining of pain to his knee. Driver of Unit 2 was treated on scene by RFA medics. Driver of Unit 1 did not report any injuries. Unit 1 had a significant front-end damage and was not drivable. The collision occurred in the intersection of 116 Ave SE and SE Petrovitsky RD. The intersection is control by traffic light device. The streetlights and the traffic lights were out due to windstorm. Upon my arrival, I collected each involved party's information and their independent recollection of their involvement leading up to the collision. The driver of Unit#1 said he was the sole occupant and was traveling northbound on 116 Ave SE approaching the intersection of SE Petrovitsky RD . The driver of Unit#1 stated traffic traveling on SE Petrovitsky RD stopped before he proceeded to enter the intersection. Upon entering the intersection, Unit#1 collided with Unit 2 causing significant front-end damages. Unit 1 was not drivable, and it was impounded to the Banker's Tow yard at the owner's request. The driver and passenger of Unit#2 stated that prior to the collision they were traveling eastbound on eastbound on Petrovitsky RD approaching the intersection of 116 Ave SE. The driver of Unit#2 stated that they entered the intersection. He stated Unit 1 entered the intersection while he was already in the intersection. Both Unit#1 and Unit#2 collided in the intersection. Based on the damages to the vehicles and their positioning, Unit 2 was already in the intersection when Unit#1 entered the intersection. Both drivers were provided with a business card and case number. PAGE 3 OF 4 REPORT NO. EF44829 CASE# 24-12006 DATE AND TIME 11/20/2406:10 OF COLLISION 11 '' ;. Wit• t e it t 1 a4 c t r z Y� �t tits r 1 C 1�fY �tt 1 PAGE 4 OF 4