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HomeMy WebLinkAbout24-11765 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67108oc� RA COLLISION REPORT 1591971 CASE# 24-11765 2 INTERSTATE CITY STREET FIRE I RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E IN eDLLISION' 11 - 13 - 2024 0757 17 =.= S 8 W E OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION BLO❑ MAPLE VALLEY HWY MILE POST e 14800 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET e S 8 W e 149TH AVE SE 2 0 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4257577177 0 1 30 6 LAST NAME SAMITOVA FIRST NAME EVDOKIA MIDDLE N 1 1 2 31 INITIAL STREET ❑ 17717133RD PL SE CITY; RENTON ST WA ZIP 980587886 2 NEW ADDRESS 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'.. 3 INTERLOCK YEs NO�/ INTERLOCICvEs No�/ YES NO 8❑ DRIVER # STATE WA SEXI F MMDDYY' 04 - 26 - 1984 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, CLY8044 STATE WA VIN#; JTMI6RFV6RD136794 3 10 Fq I as ATP rt TRAILER STATE TRAILER STATE 11 5 0 PLATE# PLATE# ROM TO TRLR zRLR 1 1 5 33 12 5 0 VIN#' VIN# FROM TO 13 4 VEH.YEAR2024 MAKE ToYT MODEL RAV4 STYLE UT VEHICLE TOYED NO�iS46LIN Tv4 EBYMEYERS GOS❑VT EHICLE Np 7 3 34 DAMAGE IIII._IIII REGISTERED OWNER INFO .TOYOTA TOYOTA OF RENTON 150SW 7TH ST RENTON WA 98057 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 14 ALLSTATE 820283657 IN EFFECT &POLICY# 9TOP v` CHARGE t S 36 LEGALLY yes❑NO❑ CITATION# 70 80TTOM 15❑ STANDING s 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR D:7199309993 16� LAST NAME RODGERS FIRST NAME DESEAN MIDDLE INITIAL STREET ❑ 37 17 ❑ 20615 93RD PL S UNIT 1 CITY KENT ST, WA ZIP 980310013 4 NEW ADDRESS 18❑ CDL IGNITION RECYUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYEs No INTERLOCK YES NO YES NO 19 DRIVE # ❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H ET 2 INJUI Y 1 NATURE OF INJURIES 40 USE CLASS 21 LICENSE CCF5647 rare WA vIN# 5TDFZRBH8NS181635 41 22❑ PLATE# STATE PLAAILER TE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2022 MAKE TOYT MODEL H/GHlAN STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO DESEAN RODGERS 1802344TH DR SE BOTHELL WA 98012 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO GEICO 6148-13.90.30 IN EFFECT &POLICY# 9TOP VEHICLE ❑ ,.I—I CITATION11 CHARGE OUR, LEGALLY YES N 25 s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.JACOBS 1953 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF67108 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11765 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) SAMITOVA SOPHIA ADDRESS&PHONE RENTON SEXi F MMDooYBYYY 12 - 20 - 2021 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES z � 1 POS. 17 6 10 1 USE 1 2 CLASS 1 ----� :NAME Lnsr EIRST,MIDDLE INITIAL) RODGERS IMAANI ADDRESS&PHONE# KENT SEX F I D•O�e• 08 _ 27 _ 2018 MMDDYYYY SEAT HELMET INJURY T NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� :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 POS. I USE CLASS NARRATIVE On 11-13-24 at about 0802 1 arrived in the 14800 block of Maple Valley Highway (MVH) for a 2 vehicle blocking collision. I contacted both vehicles still in the roadway. Unit 1 was in lane 1 and unable to move, while vehicle 2 was in lane 1 and was able to move to the shoulder. Both drivers identified themselves via WADL. Driver 1, Evdokia Samitova told me; She was driving eastbound on MVH when she had to swerve to avoid a vehicle in front of her. When she swerved she collided with unit 2. She did not see unit 2 prior to swerving and colliding with it. She nor her juvenile passenger were injured. Driver told me; He was driving eastbound on MVH in lane 1 when unit 1 suddenly swerved into his lane and collided with his vehicle. He had very little time to react and was unable to avoid the collision. He doesn't think he or his daughter were injured. Unt 1 was towed at owners request. Driver 2 pulled to the side of the road to figure out what he was going to do with his vehicle. This incident occurred in the city of Renton, County of King. I declare under penalty of perjury under Washington state law that the foregoing is true and correct. C. Jacobs/1953 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.JACOBS 02-19-25 07:59 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 2/19/2025 9:44:07 AM BADGE OR ID# j 1953 ORI# WA0171300 TIME POLICE DISPATCHED 7:59 AM TIME POLICE ARRIVED i 8:02 AM PAST B 3 Da-3mx-attar gt 1Mffp PAGE 2�OF REPORT NO. EF67108 CASE# 24-11765 DATE AND TIME 11/13/2407:57 OF COLLISION `.3 cr 10 Wow ooww i i i 3 PAGE 3 OF 3