HomeMy WebLinkAbout25-2171 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF73741oc� RA
COLLISION REPORT 1591971
CASE# 25-2171 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 03 - 10 - 2025 0926 17 =.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
NE SUNSET BLVD
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e EDMONDS AVE NE
0 6 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2062284437 0 1 30
6❑ LAST NAME MCDERMOTT FIRST NAME SEAN MIDDLE T 0 1 31
INITIAL
STREET ] 16727 SE 251 ST ST
NEW ADDRESS CITY I COVINGTON ST; WA ZIP: 98042 2
7 CDL IGNITION REQUIRED IGNITION ENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYePRES l-✓ YES NO r✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 11 — 04 — 1959 1 2 32
9 ON DUTY STATUS' AIRBAG 3 RESTR 9 EJECT,. 1 HELMET U S 2 CLASSY 6 BACK PAIN FNATURE OF JURIES 2
10 PI ENSrtEI BAL5293 STATE WA VIN# 1FMCU9D72CKA07954 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR zRLR 5 1 33
12 0 0 VIN#' vIN#
FROM TO
13 3 VEH.YEAR2012 MAKE FORD MODEL ESCAPE STYLE SV VEHICLE TOYED NO/yS46LIN diW9YMEYER YESr`-IVT ENp✓HICLE 7 3 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO SEAN MCDERMOTT 16727 SE 251STST COVINGTON WA 98042 D:2062284437 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 LIABILITY INSURANCE INSURANCE CO 4
14 PROGRESSIVE 9307t8745
IN EFFECT &POLICY# 9TOP
VEn" CHARGE 5 I < 36
LEc Ly YES❑NO❑ CITATION# t a BOTTOM
15❑ STM ING e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:4255040425
16�
LAST NAME PANKIV FIRST NAME KEVIN MIDDLE'
INITIAL
17 F1 STREET ❑
❑ 3000 SE ROYAL HILLS DR APT 31A CITY RENTON ST, yyq ZIP 98058 37
NEW ADDRESS
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCK YEs No✓ INTERLOCK YES NO✓ ves Na✓
19 DRIVER'S STATE WA SEX M D.o.e. 09 28 2005 � 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 3 RESTR 9 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS BACK PAIN
21 LICENSLATE E CKT7153 rare WA vIN# 1FTYR2CGXGKA07534 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2016 MAKE FORD MODEL TRANSIT STYLE CG VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYER vEs No✓
REGISTERED OWNER INFO KEVIN PANKIV 3000 SE ROYAL HILLS DR APT 31A RENTONWA 98058 D:4255040425 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO SAFECO H2272570
IN EFFECT &POLICY# 9TOP
1— ❑ ,J—I CITATION11 CHARGE t080TTOM
,—LY YES N
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
RAYMOND WATSON 13127 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF73741
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2171
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) PANKIV IHOR V
ADDRESS&PHONE# D�
3000 SE ROYAL HILLS DR APT 25F RENTON WA 98058 SEXi M MM DDYVYY 01 — 11 — 2005
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS[:] UNIT# 2 POS. 3 AIRBAG 3 RESTR. 9 EJECT 1 USE 2 CLASS ;7 BACKPAIN
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX MMDDYYYY D.O.B. —
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
POS. 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.
RAYMOND WATSON 03-10-25 12:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 311412025 7:50:00 AM
BADGE OR ID# j 13127 ORI# WA0171300 TIME POLICE DISPATCHED 9:27 Aryl TIME POLICE ARRIVED i 9:29 AM
PAST B 3 Do-lmx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF73741 CASE# 25-2171 OF DATE AND r�N + 03/10/25 09:26
O�COLLISION
NARRATIVE
25-2171
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized
On 03/10/2025 at approximately 0927 hours, myself, Officer R. Watson, Was dispatched to an
Accident with Unknown Injuries, at the intersection of NE Sunset BLVD and Edmonds AVE NE, within
the City Limits of Renton, County of King, State of Washington.
Dispatch advised that two vehicles were involved in a collision and one party was reporting back pain.
I arrived on scene and saw two vehicles, a 2012 Blue Ford Escape, WA Plate# BAL5293, driven by
Sean T. Mcdermott (DOB 11/04/1959) Identified by WA DOL, and a 2016 White Ford Transit, WA
Plate# CKT7153, driven by Kevin Pankiv (DOB 09/28/2005), Identified by WA DOL, involved in a
collision.
Unit#1 driven by Mcdermott, was entering onto NE Sunset BLVD from the 76-station located at 1190
NE Sunset BLVD when he stated his brakes failed and he entered traffic colliding with the other
vehicle. Mcdermott was seen by Renton Fire Department medical personnel on scene and decline
transport. The airbags on Unit#1 had been deployed and the vehicle had significant front-end
damage.
Unit#2 driven by Kevin, was traveling eastbound on NE Sunset BLVD. Kevin stated that when he
was traveling eastbound when a vehicle pulled in-front of him and he did not have time to stop. There
was also a passenger in unit#2, lhor V. Pankov
(DOB 01-11-2005). Both occupants of vehicle #2 stated their backs hurt but they were ok for the
moment. They were both seen by Renton Fire Department medical personnel on scene and declined
transport. Unit#2 had the air bag deployed and significant front-end damage.
Unit#1 was pulled off the roadway by Gene Meyer Towing and Unit#2 was towed by Gene Meyers
Towing. An exchange of information was given to both parties. Pictures were taken on scene and
uploaded to evidence.com.
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 R. Watson #13127 03/10/2025 11:01 AM, Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF73741 CASE# 25-2171 DATE AND TIME 03/10/2509:26
OF COLLISION
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