HomeMy WebLinkAbout25-80413 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-80413 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GowsloN 12 - 1-- 2025 1948 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 2400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:4259705070 30
6� LAST NAME KHOJIAKBAROV FIRSTNAME SHOKHRUKH MIDDLE 1 2 31
INITIAL
STREET ❑ 15624 158TH AVE SE CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
$ LDICENSE# STATE WA SEX'M I D-MI
ovY 03 - 08 - 2004 =32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM
USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 Fl PI ATE 14 BXV2034 STATE WA vN#' 1G1PY6S05L4134978
11[-� TRAILER STATE TRAILER STATE
11 4 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12❑ VIN#' VIN#.
Rom 34
13 4 VEH.YEAR2020 MAKE CHEV MODEL BOLT STYLE SD VEHICLE TOWED�NOOpLSABLIN TLOyyEp,&vESSTOWING VEHICLE
❑ DAMAGE IILLJJII IlVli'1L
REGISTERED OWNER INFO SHOKHROKH KHOJIAKBAROV 15624158TH AVE SE RENTON WA 98058 D:4259705070 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO GEICO 4169-24.77.82 3
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STAIN.D'ING 8 7 6
UNIT VE IA.
MOTOCLE El CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWN ARTY ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � e
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG55715
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80413
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was driving eastbound in the 2400 block of Maple Valley Hwy in the #2 lane. Unit 1 was
negotiating a curve on a wet roadway and began to hydroplane. Unit 1 lost control of the vehicle and
slid to the southern side of the roadway striking a concrete barrier with the passenger side of their
vehicle. The vehicle spun around and laid to rest in the #2 westbound lane facing eastbound.
Unit 1 reported no injuries. Unit 1's vehicle was disabled, losing the axle to the passenger front tire
and deflating the rear passenger side tire. Unit 1 was towed by Limitless Towing who was on scene
prior to my arrival to assist with blocking the collision.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by J. Turner 12650 on 12/05/2025 at 0223 hours.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 12-05-25 03:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 12/5/2025 8:08:56 PM
BADGE OR ID# 12650 ORI#' WA0171300 TIME POLICE DISPATCHED' 7:48 Pry TIME POLICE ARRIVED]7:54 PM
PART I PAGE IT]OF
REPORT NO. EG55715 CASE# ' 25-80413 DATE AND TIME 12/04/25 19:48
OF COLLISION
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