HomeMy WebLinkAbout25-3587 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF89248oc� RA
COLLISION REPORT 1591971
CASE# 25-3587 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 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#
eaCL s on' 04 - 22 - 2025 1307 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
SW GRADY WAY
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ . FEET e S 8 W e LONGACRES DR
OF 4 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2067716623 0 4 30
5 LAST NAME SYSKO FIRST NAME TARAS MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 11219 SE 234TH ST CITY; KENT ST WA ZIP; 980313492 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKVEs NO YES NO
8❑ DRIVERCENS # STATE WA SEXI M MMDDYY' 12 — 17 — 1992 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET CLASSY 14 1
NATURE of INJURIES 2
LICENSE, CES3418 STATE WA VIN# KM8SRDHF5JU294161 3
10 F PI ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR zRLR 1 1 3 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2018 MAKE HYUN MODEL SANTA STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 7 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO ANNA SYSKO 11211 SE 234TH ST KENT WA 98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE NSURANCE CO TRAVELERS 612398216 203 1
IN EFFECT &POLICY# 4TOP _
srgNOLNG YES❑ ❑ SA0333560 CHARGE FAIL YIELD LEFT TURN MOTOR o ooTrofi 36
VEHICLE NO CITATION#
15
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2066817854
16�
LAST NAME DUNN FIRST NAME KYLE MIDDLE R
INITIAL
17 F1 STREET ❑❑ 200 SW 5TH PL APT A102 CITY RENTON ST, WA ZIP 980575801 37
NEW ADDRESS
18❑ IGNITION REQUIRED (GNITION PRESENT MEDICAL TRANSPORTED. 38
CDL INTERLOCKs No INTERLOGKYEs No YEs No
19 DRIVER'S STATE WA SEX M D.CB. 12 27 1984 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE 96808C TATE WA VIN# 1FT8X3A64BECO2767 I El 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2011 MAKE FORD MODEL F350/SC STYLE 4C VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO KING DOT FLEET ADMIN 201 SJACKSON ST SEATTLEWA98104 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE[Z INSURANCE CO KC DOT TBA
IN EFFECT &POLICY# t �, o
LEEIL ❑ CO CITATION# CHARGE
EEGnEEY YES NCO
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF89248
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3587
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE CLASS 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 CIASS ----�
: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
wht/1 It from law..wht/2 It from Brady
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle non blocking crash at the
intersection of SW Grady Way at Longacres Dr.
I contacted the driver of unit 2. He told me he was east n SW Grady Way and making a left
turn/northbound onto Longacres Way when unit 1 positioned on Longacres Way made a left turn into
the back end of his truck. He did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was making a left turn from
Longacres Way onto SW Grady and contacted unit 2. He did not complain of injury and damages did
not require a tow truck.
I cited unit 1 Ref RCW 46.61.185 FTYROW left turn two vehicle crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 4/22/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-22-25 02:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY ATE
G.BARFIELD 6476 5/7/2025 9:19:05 AM
D
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:07 Pry] TIME POLICE ARRIVED i 1:13 PM
PART B 3 Da-3mx—attar(t 1Mff) PAGE F2 --]OF F3
REPORT NO. E F89248 CASE# 25-3587 DATE AND TIME 04/22/25 13:07
OF COLLISION
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