HomeMy WebLinkAbout25-0883 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-0883 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 01 - 27 - 2025 1144 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4255002791 0 4 30
6� LAST NAME GHARIBYAN FIRSTNAME ARSEN MIDDLE 1 2 31
INITIAL
STREET ❑ 27717 215TH PL SE CITY MAPLE VALLEY WA
NEW ADDRESS ST ZIP', 96038 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MED YES NoICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No
8❑ LICENSE# STATE WA SEX'M I D-MMDDYY 05 - O6 - 1997 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CCN7367 STATE WA uN# 1GNSKHKC4JR130845
10 9❑ pr ATE it
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR 2018 CHEV SUBUR UT MAKE MODEL STYLE VEHICLE TOWED TO BLIN 5 7 TOWED BY GOVT.VEHICLE 34
13 4 DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 00591665.2 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:4256810335
16 a
LAST NAME BURNETT FIRST NAME BRANDON MIDDLE j
INITIAL
17❑ STREET ❑', 1215 MO 98056 NROE AVE NE CITY RENTON ST WA ZIP 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑ 11
19 DRIVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CAZ9635 TATE WA vIN# WVWAA71K99W073355
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2009 MAKE VOLK MODEL RABBIT STYLE HB -TEHICLE
TOWED✓ TOO BLIN GENE MEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE I PORGY#E CO CALIFORNIA CASUALTY INS 1017775472 IUR
5
IN EFFECT
'E""LE ❑ ,J� CITATION# CHARGE LEGALYYES N
25 =Kl
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF61028
COLLISION REPORT III III III III III 111
1591972 CASE# 25-0883
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'
On Monday, January 27, 2025 at 1146 hours, I was dispatched to a two-vehicle collision in the area
of the NE Sunset Blvd and Union Ave NE, in Renton, WA, King County.
The following occurred within the City of Renton, King County; Unit 1 - WA/ CCN7367 was being
driven by Arsen Gharibyan and headed east on NE Sunset Blvd in the 4200 block after a. Unit 2 -
CAZ9635 was being driven by Brandon Burnett and was turning left onto NE Sunset Blvd from the
parking of the 4200 block.
Arsen stated he was driving straight ahead and did not observe Unit 2 coming into the roadway. The
front bumper collided with the front fender of Unit 2.
Brandon stated he was turning left out of the lot and did not observe Unit because the was a car
turning right into the lot before the businesses and obstructed his view of additional vehicles.
Based on the fast of both descriptions of effects are feasible, without any evidence to prove one way
or another, I am unable to determine proximate cause of the collision.
Both vehicle sustained significant damage, and one vehicle was towed from the scene.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Officer J. Wisniewski/#204 on 01/27/2025 at 1247 in Renton, WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISNIEWSKI 01-27-25 01:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
S.WOODWARD 11528 113112025 4:44:36 AM
BADGE OR ID# 12598 ORI# WA0171300 TIME POLICE DISPATCHED! 11:45 AM TIME POLICE ARRIVED 11:49 AM
PART I PAGE IT]OF
REPORT NO. EF61028 CASE# 25-0883 DATE AND TIME 01/27/2511:44
OF COLLISION
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