HomeMy WebLinkAbout25-6941 ("7—
STATE.w,-" .:.. TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 6 27c .
,one COLLISION REP F 1591971
CASE# 25-6941 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F ❑ LOCAL AGENCY 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY-
Flo
coAT sloN 08 - - 2025 0759 17 a. S e W 8 OF IN 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE PETROVITSKY RD BLOCK NO.
MILEPOST
❑ 8
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.= FEET e S e W B 128TH AVE SE
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES ,/No D:2067421559 0 4 30
6� LAST NAME : GRISSOM FIRST NAME DAMION MIDDLE' M 1 1 2 31
INITIAL
STREET E:1' 15419 SE 179TH ST CITY RENTON WA
NEW ADDRESS S7 ZIP 980589042 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL-1 NO OftTED 3
INTERLOCKYEs No,/ INTERLOCKYEs NOW YES Na,/
8❑ LDICENS STATE WA SEX'M MM flYY 01 - 20 - 2006 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 H U5 E7 CLASS 1 NATURE OF INJURIES 2
LICnNSE D4834OF srnrF WA WIN#' 3D7HA18NX2G198452
10 1❑ 3
11 3 5 PLATE# STATE PLATE# STATE ROM To
RA
TRLR TRLR. 3 7 33
12 3 5 vIN#' VIN#
FROM TO
13 2 VEH.YEAR2002 MAKE DODG MODEL RAM STYLE PK VEHICLDAMAGE TOWED Ft1 T02fBLIN TOWED BY GOVT.VEHIICL✓ 7 1 34
❑ REGISTERED OWNER INFO DAMES KIRKLAND 15419 SE 1797H ST RENTON WA 98058 D:2095136824 IL—llll VEHICLE ccNJO..'II 1
SHADE 1N DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ NSURANCE CO 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE i 5 ❑ 36
EGAD V YES❑NO❑ CITATION# 5AO744761 FAIL TO OBEY TRAFFIC CONTROL a BOTTOM
15❑ sranowc B 7 6
I�
MOTOR PEDAL �`�''� PROPERTY DAM THR OLD MET PHONE
UNIT PEDESTRIAN T Q2 VEHICLE CYCLE E] OWNER YES 1/ NO D:2532945316
16�
LAST NAME MORALES CRUZ FIRST NAME ALFREDO MIDDLE N
INITIAL
17 STREET El 23817 108TH AVE SE APT 17 CITY KENT I ST WA ZIP 980313696 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDI.CALTRANSPORTED � 38
WTERLOCKvEs No INTERLOCK Es N YES No,�
19[l DRIVER'#
ON DUTY EA STATUS AIRBAG 9 RESTR 9 EJECT 1 N U MEET INJU CLARY 1 NATURE of INJURIES 40
❑21❑ LICENSE A8519826 rAre WA vIN# 2CNFLCEC5B6259563 41
1
PLATE#
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23� 43
TRLR RLR
VIN#. '[N#,
2011 CHEV EQUINOX TOWED Br Go HI 44
VEH.YEAR MAKE MODEL STYLE DAMIAGE TOWED✓ ND BLIN GENE MEYERS TOWING YES NO�/
24
REGISTERED OWNER INFO ALFREDO MORALES CRUZ 23817 108TH AVE SE APT I7 KENT WA 98031369E VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE INSURANCE CO DIRECTAUTO INSURANCE 2029973150
IN EFFECT &POLICY#
Venice ❑ CL] CITATION# CHARGE tOBOTTOM
LEGALLY YES N J
25 7JEE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
VANDERHOEK 11631 WA0171300
PAGE 01 OF
PARTA9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG17641
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6941
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) LYKES ALAYNA
ADDRESS&PHONE
2532733957 SEXi F MMDD'yyYy 01 - 20 - 2003
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ �' POS. USE CLASS ----�
:NAME
(LAST FIFS7 MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYYYY D.O.B. -
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES
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 westbound on SE Petrovitsky Rd, in the right lane approaching 128th Ave
SE. Vehicle #2 was facing eastbound on SE Petrovitsky Rd, in the left turn lane, preparing to make a
left turn onto 128th Ave SE. As vehicle #2 turned left onto 128th Ave SE, vehicle #1 proceeded
through the intersection, causing the front right corner of vehicle #1 to collide with the right side of
vehicle #2. This caused vehicle #2 to roll onto his left side. The driver of vehicle #1 stated his light
was yellow when he made the decision to proceed through the intersection, but he believed his light
may have turned red by the time he actually entered the intersection. The driver of vehicle #2 stated
his left turn arrow was green when he made the left turn. Based on the totality of the circumstances, it
appeares the driver of vehicle #1 was the proximate cause of the collision.
RTF
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 08-10-25 09:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 811012025 3:36:02 PM
BADGE OR ID# ; 11631 ORI# WA0171300 TIME POLICE DISPATCHED 8:01 AM TIME POLICE ARRIVED i 8:06 AM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EG17641 CASE# 25-6941 DATE AND TIME 08/10/25 07:59
OF COLLISION
r�
a" s
r�
4
c
�f 4
r,
1 �
U3'
rr,I ,`ti$ wWHra
5��•" it
t t.
� 3
?
t
l §
�t� � .o F� � i `fi✓.
PAGE 3 OF 3