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HomeMy WebLinkAbout25-80051 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG51204oc� RA COLLISION REPORT 1591971 CASE# 25-80051 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL ACENC'Y 4100 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TRIBAL TOTAL UN TS#OF 01 TRUCK BJECT 1 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsfoN' 11 - 21 - 2025 1813 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION NE 4TH ST BLOCK NO, e 4400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�.� FEET e S B W 0 1 29 MOTtlR PEDAL- DAM G THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES'Vl No D:4433628467 30 6❑ LAST NAME CHAVEZ FIRST NAME MAGDELENA MIDDLE M 1 2 31 INITIAL STREET ❑ 1319 S PUGET DR,APT D32 CITY RENTON ST WA ZIP 98055 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs ND INTERLOCKYEs NO YES F NO $ DRIVER'S STATE WA SEX U MMDDYY' 03 — 31 — 1999 32 STATUS AIRBAG 1 RESTR 13 EJECT 3 HELMET INJURY 6 NATURE OF INJURIES 2 9 ON DUTY❑ USE CLASS LAC TO FACE,ROADRASH ON HANDS 10 as ENSrtEI NONE STATE WA VIN# JH2KF0109HK203272 3 TRAILER STATE TRAILER ,STATE 11 0 0 PLATE# PLATE# FROM To rRLR TRLR 3 7 33 12 VIN# VIN FROM TO VERYEAR 1987 MAKE HOND MODEL CH150 STYLE MS VEHICLE TOWED,DLt�TO-'BLIN TOWED By GOVT VEHICLE m 34 DAMAGE YES II_II NO YESII-1) NO 13 REGISTERED OWNER INFO DMITRIYGAYVORONSKY1801 PIKE STNE AUBURN WA 98002 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ NSURANCE CO NONE �g_ IN EFFECT &POLICY# 68`SOP VEHICLE CHARGE ❑ 36 EcnuY YES❑NO❑ CITATION# BOTTOM 15❑ TANowc �y MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE UNIT©2 PEDESTRIAN VEHICLE CYCLE' OWNER YES NO 16❑ LAST NAME FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY ST ZIP ❑ 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYEs ND INTERLOCK YES0-001 Es NO' 19 LICIENSE# STATE SEY MMDDYY' -� 39 HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASSLICENSE ❑ 21 PLATE# TATE VIN# 41 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 43 23 RLR VfN 'N UIN#. 'IN#. VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP VEHICLE ❑ ,.I—I CITATION# CHARGE tO BOTTOM LECALLY YES N`LJ 25 a a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 N.ODALOVIC 11628 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG51204 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80051 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME HUYNH WESLEYN (LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# RENTON 5037581175 SEX U MMoovYYv 10 — 03 — 2000 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS TU 'NAME LAsr F RST,MIDDLE INITIAL) KATZ JENNIFER ADDRESS&PHONE# RENTON 2533476976 SEX U D.O.B. _F_[---------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ �✓ POS. USE CLASS ----� NAME MIDDLE INITIAL) SCHMIDT ERIKA L ',(LAST,FIRST, AODREss a PHONE# 1319 S PUGET DR#D32 RENTON WA 98055 3026688205 SEX, F D.O.B. 03 _ 27 _ 1999 MMDDYYYY PASSENGER❑ Q WITNESS UNIT# SST AIRBAG RESTR. EJECT HELMET I POS. NJURY USE CLA SS NATURE OF INJURIES 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. N.ODALOVIC 11-21-25 09:26 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 1 1112212025 1:13:56 AM BADGE OR ID# 11628 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:13 PM TIME POLICE ARRIVED 7:98 PM PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47 REPORT NO.` EG51204 CASE# 25-80051 O COLLI COLLISION TIME OF 11/21/25 19:13 COLLI NARRATIVE 25-80051 Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 11-21-2025 at approximately 1913 hours I was dispatched to a collision that occurred in the 4400 block of NE 4th St. I arrived at approximately 1916 hours and met with the driver Magdelena of a scooter (unit 1), who was injured laying on the sidewalk. Unit 1 was traveling westbound on NE 4th St in lane 2 (closest to the north sidewalk). The driver just purchased a scooter and had a companion/witness Erika traveling behind in another vehicle. A black SUV was reported to have changed lanes from lane 1 to lane 2, which caused unit 1 to lose control and strike the sidewalk. The driver of unit 1 had a laceration to the face and road rash. The driver was transported to Valley Medical Center (400 S 43rd St) to further evaluation. Witness Wesley captured the event on a camera in his vehicle. The black SUV did not appear to make contact with unit 1, and it is unknown at this time if the driver of the black SUV knew unit 1 was involved in a collision due to their actions. The license plate of the black SUV was not readable from the footage. The scooter was impounded to Gene Meyer Towing. I photographed the damage to the scooter which was uploaded to evidence.com. Please forward this case to the Traffic Investigations Unit for review. During this incident it is likely my body-worn and/or in-car camera was recording audio and video. This report is merely a summary of the incident and is not intended to be an exact transcription of the entire investigation or what may have been captured with the recording system. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by N. Odalovic#11628 on 11-21-2025 at 2100 hours in Renton, WA. PAGE 3 OF 4 REPORT NO. EG51204 CASE# 25-80051 DATE AND TIME i 11/21/25 19:13 OF COLLISION 4 � a Ott r ti. 4 t e ` a } 5• { i s tr, i PAGE 4 OF 4