HomeMy WebLinkAbout25-6230 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG16643oc� RA
COLLISION REPORT 1591971
ASE# 25-6230 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4100 3
COUNTY RD ❑ NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 07 - 19 - 2025 2127 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
NE SUNSET BLVD
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET H S 8 W e EDMONDS AVE NE
0 1 29
MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2532261523 0 6 30
5 LAST NAME GOVORUSHKIN FIRST NAME YEVGENIY MIDDLE 1 1 2 31
INITIAL
STREET ❑ 1709 SHELTON AVE NE CITY RENTON ST I WA ZIP 980563359 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO✓ INTERLOCKYEs Na✓ YES D NOZ
8 LICIENSE# STATE WA SEX M MMDO orYY' 05 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT, 1 HELMET 2 INJURY 7 NATUREof IN HELMET 2
USE ,CLASS PAIN/N LEFT ARM
10 1 LICENSuE! BUC8575 STATE WA VN# 2T1BURHE2HC794342 3PI ATr �
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR TRLR 3 7 33
12 0 0 VIN# VIN#
'.....: FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 Y GOS VEHICLE 3 7 34
13 4 2017 TOYT COROL SD DAMAGE ves ✓ No � �MEYERS Yes❑ No✓
REGISTERED OWNER INFO YEVGENIY GOVORUSHKIN 1709 SHELTON AVE NE RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 4
14 ✓ PROGRESSIVE 71588367
IN EFFECT &POLICY# 9TOP
vEnic�E 5 36
LEGALLY YES[:]NO[:] CITATION# CHARGE 7 o BOTTOM
15❑ STANDING I a
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ nWNFR YEs No �/ D:2068590556
16�
LAST NAME SEMA FIRST NAME ABERASH MIDDLE K
INITIAL
17 F1 STREET ❑❑ 3810 S 158TH ST APT C7 CITY TUKWILA ST, WA ZIP 981882670 4 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNTION PRESENT MEDICALTRANui"PQRTED 38
INTERLOCKYEs No✓ jNTERLOGKYEs No✓ rEs No;✓
19 DRIVER'S STATE WA SEX F I D-O... 07 23 1985 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 HELM USE ET 2 INJURY
1 NATURE OF INJURIES 40
21 LICENSEPLATE# BEE0782 TATE WA VIN# JTEES42A182070051 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 200$ MAKE TOYT MODEL HIGHlAN STYLE UTVEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO MERID BOGER IIIWS 158TH STAPT C7 TUKWILA WA 98188 VEHICLE NO.2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE✓ INSURANCE CO PROGRESSIVE 923776847
IN EFFECT &POLICY# t 9TOP
LVEHICLE
EIAILY YES❑ N CL J CITATION# CHARGE tO BOTTOM
LEGALL
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG16643
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6230
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME BOGER MERID A
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O
3810 S 158TH ST APT C7 TUKWILA WA 981882670 SEX' M MMooYYYv 01 - 05 - 1966
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
E j 2 POS. 3 2 4 1 USE 2 OLASS 1 ��---�
'NAME
LAsr F RST,MIDDLE INITIAL) MERID ELLIOTT A
ADDRESS&PHONE# D C,B
3810 S 158TH ST APT C7 TUKWILA WA 98188 SEX' M MMDDVVYv 11 _ 02 _ 2015
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS UNIT# i 2 POS. 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----�
NAME MIDDLE INITIAL) MERID HARRY
',(LAST,FIRST,
AODREss a PHONE# 3810 S 158TH ST APT C7 TUKWILA WA 98188 D.O.B.
M 08
SEX _ 21 _ 2017
MMDDVYYY
PASSENGER Z WITNESS UNIT# 2 SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
Q POS. USE CASS
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.
KEVIN PETERSON 07-21-25 02:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 8/6/2025 8:18:39 PM
BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:48 PM TIME POLICE ARRIVED 9:48 Pm
PART B 3aaa-345-,ao(R11r1s) PAGE 27OF 57
POLIICFETRAFFICN CORRECTION REPORT NO. EG16643
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6230
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MERID EPHRATA
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE#
3810 S 158TH ST APT C7 TUKWILA WA 98188 SEX' F MMooYYYv 07 — 11 — 2019
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET LASS NATURE OF INJURIES
E', 2 POS. 10 2 4 1 USE 2 CLASS 1
'NAME
(LAST FIRST,MIDDLE INITIAL) MERID ARON
ADDRESS&PHONE# D O B
3810 S 158TH ST APT C7 TUKWILA WA 98188 SEX' M MMDDYVYv 10 _ O6 _ 2022
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# i 2 PCS 10 AIRBAG 2 RESTR. 10 EJECT 1 USE 2 CLASS 1
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M _� 1I
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR, EJECT HELMET INJURY NATURE OF INJURE
❑ Q POS. 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.
KEVIN PETERSON 07-21-25 02:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 8/6/2025 8:18:39 PM
BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:48 PM TIME POLICE ARRIVED 9:48 Pm
PART B 3 Do-3mx-,ao(Rtrras) PAGE 37 OF 57
REPORT NO.` EG16643 CASE# 25-6230 O COLLI COLLISION TIME
OF 07/19/25 21:27
COLLI
NARRATIVE
I was dispatched to a collision on 07/19/25 at 2148 hours I was dispatched to a collision at NE Sunset
Blvd and Edmonds Ave NE, in city Renton, King County WA.
Unit 1 BUC8575 Driver: Yevgeniy V. Govorushkin (DOB 05/11/1988)
Unit 2 BEE0782 Driver: Aberash K Sema (DOB 07/23/1985)
1 contacted both parties Unit 1 stated that he was traveling in lane two traveling West on NE Sunset
Blvd when approaching the Edmonds intersection, the light turned yellow. Unit 2 then stopped for the
light and unit 1 did not have enough time to stop and hit unit 2. Unit 1 stated he thought unit 2 was
going to go through the intersection on the yellow.
Unit 2 was traveling West on NE Sunset Blvd when approaching the intersection of Edmonds Ave
NE, the light turned yellow and Unit 2 stopped for the light. Unit 1 then hit the back of unit 2 while they
were sitting at the light.
Unit 1 was seen by Renton Fire for airbag deployment and pain to left arm. All personal in unit 2
stated no injuries and did not want to see medics.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 07/20/2025, 0207 hours at Renton,
WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 2
Seat Position (Passenger EPHRATA MERID): CENTER ROW DRIVER SIDE
Seat Position (Passenger ARON MERID): CENTER ROW PASSENGER SIDE
**** END OF AUTO-POPULATED SECTION ****
PAGE 4 OF 5
REPORT NO. EG16643 CASE# 25-6230 DATE AND TIME i 07/19/25 21:27
OF COLLISION
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