HomeMy WebLinkAbout25-4058 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF90488OLCERA
COLLISION REPORT 1591971
CASE# 25-4058 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LdCCOAGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY ❑ INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 03 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDLL s oN' 05 - 08 - 2025 0650 17 =.= S 8 W e IN OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
156TH AVE SE BLOCK NO. e 13000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4252298070 0 7 30
6 LAST NAME KRUPP FIRST NAME KAITLYN MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 19004 SE 168TH ST CITY; RENTON ST WA ZIP' 980580815 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No✓ INTERON Km E ✓ vEs NO✓
8 DRIVER # STATE WA SEXI F MMDDYY' 05 - 29 - 1994 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RE
9 EJECT 1 N USE CLASSY',1 [NATURE of INJURIES 2
3
10� pj��5�' BQG9064 STATE WA yIN# 1C4PJMASOHW646134
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR TRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2017 MAKE JEEP MODEL CHERO STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE g 9 34
13� DAMAGE YES�NO ✓� YES NO✓
REGISTERED OWNER INFO KAITLYN KRUPP I..SE 168TH ST RENTON WA 98053 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 PROGRESSIVE 954243278
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES[:]NO[:] CITATION# i o 80TTOM
15❑ sTnNowc s 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ nWNRR YEs✓ No D:2532457455
16�
LAST NAME KARASHCHUK FIRST NAME ILONA MIDDLE V
INITIAL
17 F1 STREET ❑❑ 37 4017 S 344TH ST CITY'AUBURN ST, WA ZIP 980019545 4
NEW ADDRESS
18❑ CDL IG EQUIRED DICAL IGNITION R IGNITION PRESENT ME TRANSPORTED: 38
INTERLOCKYEs NO✓ INTERLOCK YES NO✓ YES NO✓
19 DRIVER'S STATE WA SEX F I D.O.B. 09 04 1997 39
LICENSE# MMDDYY -
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY❑ STATUS AIRBAG 3 RESTR 9 EJECT 1 USE CLASS 1 ❑
21 LICENSE I PLATE# BKG8682 rare WA vIN# 19UUB1F51FA027748 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2015 MAKE gCUR MODEL TLX STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO✓
REGISTERED OWNER INFO ILONA KARASHCHUK 4017 S 344TH ST AUBURN WA 98001 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 492 0930-E19.47
IN EFFECT &POLICY#HICLE EEILe
L YES� NJ—I CITATION11 CHARGE <E�Da
VE
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JESSE VANDERHOEK 11631 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF90488
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4058
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 INJURY 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 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
Vehicle #1 was traveling northbound in the 13000 block of 156th Ave SE, Renton. Vehicle #2 was
facing north stopped for traffic in the 13000 block of 156th Ave SE. Vehicle #3 as facing north
stopped for traffic on 156th Ave SE directly in front of vehicle #2. The driver of vehicle #1 advised
she was following too closely and failed to stop in time to avoid colliding with the rear end of vehicle
#2, which in turn was pushed into the rear end of vehicle #3.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 05-08-25 11:09 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 5/12/2025 4:08:51 AM
BADGE OR ID# j 11631 ORI# WA0171300 TIME POLICE DISPATCHED; 7:06 AM TIME POLICE ARRIVED i 7:13 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF 4
SUPPLEMENTAL REPORT No. EF90488
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE# 25-4058
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY:
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # PLACARD
GWUR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
'J MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE CYCLE CI PEDESTRIAN :.. OWNER YES NO
D:2534326612
0 7 29
LAST NAME BOON FIRST NAME DONALD MIDDLE' F
INITIAL
STREET 30
NEW AnnRFs 10605 SE 212TH ST CITY KENT I ST WA ZiP gg031
6 ❑ 1 1 2 31
CDL IGNITION REOUIRE6 I{iNi71ON PRESENT MECiICALTANSPORTED'.
INTERLOCK YES. NO�/ .INTERLOCK YEsLl NG
DRIVER'S D.O.B 2
LICENSE' WA SEx M MMDD' 10 - 12 - 1955
7
ON DUTY STATUS AIRBAG 2 RESTR. g EJECT 9 HELMET INJURY 1 NAruREofINJURIEs
USE ;CLASS
8 ❑ 1 32
LICENSE 670301R TAT WA uIN 1FTZR45E93PB34851
PLATE#
9 � TRAILER TRAILER L
PLATE# STATE PLATE STATE
0
10 TRLR TRLR
VIN#. VIN#.
11 3 5 VEH.YEAR2003 I MAKE FORD M°DELRANGER STYLE PK VEHICLE TOWE E T ABLIN TOWED BY GovT vEHICI E FROM To
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFODONALD BOON 10605 SE 212TH ST KENT WA 98031 § g 33
12 � SHADE IN DAMAGED AREA
LIABILITY
4 FROM TO
INSURANCE❑ INSURANCE CO 7t)P
IN EFFECT &POLICY# 1 '"``-" m 34
13 ❑ V..... YES�e NO CITATION# CHARGE 1080TTOM
ecauv
s-rANoiNc
MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YEEF-1 NO PHONE
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET �' CITY ST ZIP
n>EW ADDRFsa
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YES NO INTERLOCK YEs NO 'YES NO ❑
17 5 37
LIRIVER'SCENSE# STATE SEX Moog _ C----�
18 ❑ ❑
HELMET 'INJURY NATURE OF INJURIES 38
ON DUTY STATUS' AIRBAG RESTR. EJECT USE CLASS.
19 ❑ ❑ 39
LICENSE TAT viN#
PLATE#
20 TRAILER' TRAILER 40
PLATE#. STATE PLATE# - STATE ❑
21 ❑ ❑ 41
TRLR TRLR
VIN# VIN#.
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT &POLICY# 7 _?�(7P_.__ S. 44
24 ..IWDIGYES❑ O
CITATION# CHARGE
E:j
STwN 8 3 G
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 05-08-25 11:09 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
�D# APO %
ORIWA0171300 APPROVED BY
DATE
2 PAGE F26 BADGE
11631 # OF
3000-345-013(R 11t18)
REPORT NO. E F90488 CASE# 25-4058 DATE AND TIME 05/08/25 06:50
OF COLLISION
t.
1;
3
m
I ,
I i
I
n
PAGE 4 OF 4