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HomeMy WebLinkAbout25-4337 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF95169OLCERA COLLISION REPORT 1591971 CASE# 25-4337 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCALANG 4200 3 C©DINGCOUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 04 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# BOLL s oN' 05 - 16 - 2025 17 1543 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE PETROVITSKY RD BLOCK NO. e 11400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET B S B W e 1 9 29 MOTOR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 0 1 30 6 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET ❑ CITY', ST ZIP 2 NEW ADDRESS 7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs No INTERLOCKYEs No YES NO 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 0 NATURE of INJURIES 2 LICENSE, 3 10� PI ATP# STATE V(N TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR TRLR 7 3 33 12 3 5 VIN# VIN# FROM TO VEH.YEAR MAKE JEEP MODEL UNKNO STYLE VEHICLE TO YED,DLt�TO BUN TOWEBBY GOVT VEHICLE 7 3 34 13� DAMAGE YES II_II NO `/ YESII_I) NO REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 4TOP V""' CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 7 0 BOTTOM 15❑ STANDING s 7 6 UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLDMET PHONE 1T 02 VEHiC1.E CYCLE nWNFR YES / NO 16� LAST NAME EBENDE IFOTO FIRST NAME PATRICK MIDDLE N INITIAL 17 F1 STREET ❑❑ 37 10621 NE 12TH ST CITY' BELLEVUE ST, WA ZIP 980044327 g NEW ADDRESS 1$� IGNITION REQUIRED IGNITION I PRESENT MEDICALTRANSPORTED' 38 CDL INTERLOCKYEs No INTERLOCK YEs No yEs Nay 19 DRIVER'S STATE WA SEXIM I D.O.B. T 08 20 1984 � 39 LICENSE# MMDDYY HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSLATE E CSD9629 rare WA vIN# JM3TB38V690165449 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2009 MAKE MAID MODEL CX--9 STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYERS E REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADE IN DAMAGE,�,AREA 2 3 �k LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2026702374 IN EFFECT &POLICY# 9TOP YewCLs LEGALLY YES❑ N,.I—I I CITATION# CHARGE to BOTTOM `,L 25 s 7 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 C.ARNOLD 12509 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF95169 COLLISION REPORT III III III III III 111 1591972 CASE# 25-4337 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 0,SS ----� :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. C.ARNOLD 05-16-25 05:27 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE C.JACOBS 1953 5/27/2025 10:02:13 AM BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:44 PM TIME POLICE ARRIVED i 3:48 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5 REPORT NO. EF95169 CASE# 25-4337 OF DATE AND r�N + 05/16/25 15:43 O�COLLISION NARRATIVE RTF 25-4337 On 5/16/2025 at 1603 hours I was dispatched to a motor vehicle collision at around 11400 SE Petrovitsky Rd in the City of Renton, King County, Washington. Pre-Collision Driver 4 stated that she was traveling East on SE Petrovitsky Rd in the #2 lane at around the 11400 block. Driver 3 stated that she was traveling East on SE Petrovitsky Rd in the #1 lane at around the 11400 block. Driver 2 stated that he was traveling Eastbound on SE Petrovitsky Rd in the #2 lane at around the 11400 block. Driver 1 fled the scene and was unable to provide comment on this collision. Collision Driver 4 stated that while traveling Eastbound, the front bumper of Unit 3 collided with the rear bumper of Unit 4. This was caused when the front bumper of Unit 1 struck the rear bumper of Unit 2, forcing Unit 2 into lane 1 and the front bumper of Unit 2 to collide with the rear drivers side bumper of Unit 3. All drivers gave their account of this story, however, only Driver 1 saw Unit 1 and was able to describe it as an older model gray Jeep of unknown model. Injuries No injuries reported Vehicle Disposition Unit 2 and 3 were towed from the scene. Proximate Cause The proximate cause of this collision is Unit 1 for following more closely than is reasonable and prudent. Driver 1 also committed the crime of hit and run attended, however no other drivers are able to identify the driver of Unit 1. I certify (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. Arnold #12509 at 17:20 on 5/16/2025 in the City of Renton, King County, Washington. **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Motor Vehicle Unit 1 Action Code: UNABLE TO DETERMINE **** END OF AUTO-POPULATED SECTION **** PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EF95169 POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 25-4337 t113197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 1 $ 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD GWVR : NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT 3 VEHICLE ( CYCLE ❑ PEDESTRIAN OWNER ❑'. YES NO 0 1 29 INITIAL LAST NAME GUARANGO ARMIJOS FIRST NAME , YESENIA MIDDLE E : 0 1 STREET 30 NEW ADORE 112 SW 154TH ST CITY BURIEN ST Wq ZIP 981662316 6 PRESENT MEDICALTANSPORTED: 1 1 2 31 CDL IGNITION REQUIRED IGNITION INTERLOCK YES D NO .;INTERLOCK YES N .YES N L DRIVER'S STATE WA SEX F 10 LICENSE MMDDYYY - 01 - 2003 7 ❑ ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 9 HELMET INJURY 1 NAruREofINJURIEs USE :CLASS 8 ❑ 1 1 2 32 LICENSE'CNJ2029 TAT WA VIN 3VWRM81K58M099558 PLATE# 9 � TRAILER TRAILER 2 PLATE# STATE PLATE# STATE 10 TRLR TRLR _VIN.#. VIN.#. 11 3 5 VEIL YEAR2008 MAKE VOLK MODELJETTA STYLE VEHICLE TOWE E T ABLI T�W?fV'ERS GovT.vFHICI E FROM To DAMAGE YES�/ NO YES NO REIVER MOLINA ORTIZ 28705 34TH AVE S APT L104 AUBURN WA 98001 7 3 33 12 3 5 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA INSURANCECO 2 4 FROM TO IN EFFECT OP 5 7 3 N EFFECT &POLICY# IT 34_ 1080TTOM 13 vewcEe YES[:] NO❑ CITATION# CHARGE �: ecauv s-rANolNc fi 7 DAMAGE THRESHOLD MET PHONE 35 14 UNIT# 4 MOTOR PEDAL- ❑ PEDESTRIAN ❑ R20RERTY YES NO VEHICLE CYCLE OWNER �/ D:2068187081 15 LAST NAME FIRST NAME PALICHUK DIANA MIDDLE' 36 P INITIAL 2 STREET 16 ❑ ❑': 17903 SE 258TH ST CITY; COV/NGTON ST.. WA ZIP 980425825 NEW ADDRESS" COL. IGNITION RE6UIRED IGNITION PRESENT MEDICAL TANSPORTED 17 ❑ INTERLOCK YES N :INTERLOCK YES NO :YES NO. ❑ DRIVER'S STATE WA SEX F D.O.6 37 LICENSE MMDDVY 04 - 08 - 2003 18 ❑ ❑ 4 HELMET .INJURY NATURE OF INJURIES 38 ON DUTY❑ STATUS AIRBAG I2 RESTR. EJECT 1 USE CLASS. 1 19 ❑ LICENSE' ❑ PLATE# B WJ9246 TAT WA vt N# 4T16646K19U102461 39 20 TRAILER I I TRAILER 40 PLATE# STATE PLATE# STATE ❑ 21 ❑ TRLR TRLR 41 VIN#�, VIN#Y 42 22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE 2009 TOYT CAMRY DAMAGE YES NO YES NO IV 23 REGISTERED OWNER INFOPAVLO PALICHUK 17903 SE 258TH ST COVINGTON WA 98042 SHADE IN DAMAC ED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYINSURANCE 1957.6850-01-92-FPPA-WA t Fg)(7P_._ 44 ❑ &POLICY# •_"_ vewcEe ❑ ❑ CITATION# CHARGE 70 BOTiC?M 24 I..EGALLY YES NO STIWDING 3� 3 G I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.ARNOLD 05-16-25 05:27 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED BADGE 1 APPROVED 12 �ORIWA0171300 A 2712025PAGE26 12509 OF ORID# # 3000-345-013(R 11t18) REPORT NO. EF95169 CASE# 25-4337 DATE AND TIME 05/16/2515:43 OF COLLISION> ' 9�k � ti i ill � 3 l 4,. 4s c t Y F a } S; a S a 3 Y � } i (u� � z r c PAGE 5 OF 5