HomeMy WebLinkAbout25-10037 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EG54763
COLLISION REPRT 1591971
CASE# 25-10037 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4200 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
COLLISION' 11 - 18 - 2025 1342 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
PARKAVEN MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e N 2ND ST
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2065493254 0 1 30
5 LAST NAME DUKURAY FIRST NAME ALIE MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 212 S TOBIN ST APT 1 CITY RENTON ST I WA ZIP 980575339 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO INTERLOCKYEs NO YES NO
8 �CIENSE# STATE WA SEX M MMOCSYY' 01 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE', BUH6655 STATE WA VN# 2FMDK49C18BB26731 3
11[—j— TRAILER STATE TRAILER STATE RON To
11 2 5 PLATE# PLATE#
TRLR TRLR 3 7 33
12 3 0 VIN# vN#
'.....: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN �tpy/E�IZ GOVT VEHICLE g 1
13 2008 FORD EDGE DAMAGE YES�NO� �"-"'" �RS 34
YE NO
REGISTERED OWNER INFO ALIEDUKURAY212 S TOBIN STAPT I RENTON WA 980575339 D:2065493254 VEHICLE NO. 1
2 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 4TOP _
srgNOLNG Yes❑NO❑ CITATION# 5A0900766,5AO900766 CHARGE FAIL STOP AT STOP o ooTro6 36
15
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES I/ NO D:2066179010
16�
LAST NAME SOVA FIRST NAME W MIDDLE' D
INITIAL
2
17 STREET ❑'❑ 8114 SE 451 ST ST CITY 37
ENUMCLAW ST, WA ZIP 980229204
NEW AbORESS
18❑ CDL IGNITION REQUIREDGNITION PRESENT MEDICALTRAN3PORTED 38
INTERLOCKYEs No INTERLOCK YES No YEs NU'
19 DRIVER'S STATE WA SEX M D.os. 10 15 1960 39
LICENSE# MMD6YY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN� B71707P TATE WA "IN# 3D7MU48C44(3102193 41
PLATE 22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2004 MAKE DDD(�' MODEL RAMPU STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO SHANA SLUM 28114 SE 451ST ST ENUMCLAW WA 98022 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO CINCINNATI A01 1225618
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ ,.I—I CITATION# CHARGE t080TTOM
LEGALLY YES N J
25 s e
rOFFLIl'tER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
VERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG54763
COLLISION REPORT III III III III III 111
1591972 CASE# 25-10037
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.
M.LEVERTON 11-18-25 02:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 121312025 7.50:52 AM
BADGE OR ID# Y517 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 1:42 PM TIME POLICE ARRIVED 1:48 pry]
PART PAGE 27 OF 47
REPORT NO.` EG54763 CASE# 25-10037 O COLLI COLLISION TIME
OF 11/18/25 13:42
COLLI
NARRATIVE
blu/2 lane 1 nb wht/1 stop sign cross
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at the intersection
of Park Ave N at N 2nd St.
I contacted the driver of unit 2 who told me he was northbound on Park Ave N when unit 1 pulled
across his lane of travel with no room to avoid contact. He did not complain of injury and damages
did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was trying to cross Park Ave N
from N 2nd St when the collision took place. Unit 1 told me it was "his fault" for the crash. He told me
he did not have insurance for his vehicle. He did not complain of injury and damages did require a
tow truck.
Unit 1 failed to stop and then proceed without hazard and drove on a public roadway without valid
proof of insurance.
cited unit 1 Ref RCW 46.61.190 and Ref RCW 46.30.020 No Insurance 2 vehicle crash via
complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 11/18/2025
PAGE 3 OF 4
REPORT NO. EG54763 CASE# 25-10037 DATE AND TIME i 11/18/25 13:42
OF COLLISION
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PAGE 4 OF 4