HomeMy WebLinkAbout25-1096 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SASE 25-1096 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 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# ❑
cawsloN 02 - 1-- 2025 2028 17 ❑.❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
CEDAR AVE S BLOCK NO. e✓ 600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FEET MILES e S B W e S 8TH ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:4254307400 1 4 30
6� LAST NAME GOURAS FIRSTNAME ALEXANDER MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 3555 NE 2ND ST TON WA
''NEW ADDRESS ST zIP', 98059 2
CITY REN
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� 54908D sTATe WA urN# JL5BSE1A4CK009128
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
FROM VEH.YEAR ZO12 MAKE FORD MODEL F STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 34
13 4 DAMAGE YES NO ✓ YES[:] ✓
REGISTERED OWNER INFO CITY OF RENTON 3555 NE 2ND ST RENTON WA 98059 D:4254307400 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCE CO SELF INSURED CITY OF RENTON 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
res❑NO❑ CITATION# 10 BOTTOM
15❑ LEGALLY
STAIN."' 6
UNIT a2 VE IOOR Z CYCLE ❑ PEDESTRIAN ❑ PROPERTY ❑ DYES✓ NO OLDMET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
17
INITIAL
STREET CITY CINCINNATI ST ZIP
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LLIICENS RIVEWS# STATE SEX U MMDDYY 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG g RESTR g EJECT '1 USE 9 CLASS 0 ❑
21❑ LICENSE HSS9915 TATE OH VIN USE
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2025 MAKE HOND MODEL ACCORD STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO AIDEN POE 3735 HERMES DR CINCINNATI OH 45247 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 5
vETILE ES❑ N,J� CITATION# CHARGEUR
LEGALLY Y
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 771�017
NCY
26
C.PAGET 8650 1300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF64014
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1096
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.
C.PAGET 02-03-25 10:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THiELMAN 11462 2/9/2025 5:05:28 PM
BADGE OR ID# 8660 OR]# WA0171300 TIME POLICE DISPATCHED', 8:34 PM TIME POLICE ARRIVED',8:44 PM
PART I PAGE IT]OF 4�
REPORT NO. EF64014 CASE# 25-1096 OF COLLISION
02/03/25 20:28
OF CbLLI510N
NARRATIVE
25-1096 Collison -non injury
RTF
Axon:
Axon body cam available
Photos:
Photos uploaded to Axon evidence.com
Note:
Vehicle 1 is a Make/Fuso Model/Pickup VIN/JL6BSE1A4CK009128 Plate/54908D (exempt) -Sector
does not recognize this make/model combination so a Ford was entered instead
Narrative:
On 02.03.2025 at 2044 hours, I arrived at a Collison which occurred at 2028 hours in the 600 block of
Cedar AVE S. This address is within the city limits of Renton, County of King, WA.
I spoke to City of Renton employee Alex R Gourdas DOB/12.09.1990. Gourdas is driving a city of
Renton snow plow a Make/Fuso Model/Pickup VIN/JL6BSE1A4CK009128 Plate/54908D due to the
snow. Gourdas was identified by photo WADL and has valid DOL status. As Gourdas passed a light
blue Honda Ohio/ HSS9915 which was parked in front of 600 Cedar AVE S, the plow on his truck
scraped the driver's side front quarter panel and driver's door. This car was unoccupied on the west
side of the street facing south. This vehicle was parked close if not more than the legally allowed 18"
from the curb. The street is very narrow. The owner of the Honda is Aiden Poe, and we have no
contacts with that name in Renton Records. A copy of the exchange of information was placed in a
bag and placed on the windshield of the Honda. No injuries and no damage to the snow plow.
Employee Gourdas told me that he will complete an Origami incident report when he returns to the
office.
Case for information purposes only
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Paget/8660 2/3/2025 10:00 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF64014 CASE# 25-1096 DATE AND TIME 02/03/25 20:28
OF COLLISION
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