HomeMy WebLinkAbout25-80777 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-80777 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 12 - 1-- 2025 0610 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a MONROE AVE SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2534575984 0 7 30
6� LAST NAME RIKARD FIRSTNAME STEPHEN MIDDLE V 1 1 2 31
INITIAL
STREET ❑ 113 BENT TREE LN CITY PACIFIC ST I WA 2jp, 98047 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� AOE9367 sTArI WAurN# JTDKDTB36G1136739
11[-� TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
TRLR. TRLR 5 1 33
12 4 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2016 TOYT PRIUS DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO VLADIMIR RIKARD 113 BENT TREE LN PACIFIC WA 98047 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDIN 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a : OWNER ❑ YES 1/ NO D:2064825849
LAST NAME LILJE FIRST NAME MATT MIDDLE
INITIAL
17❑ STREET ❑, 6105THAVE CITY' SEATTLE ST WA ZIP 98114 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVE # STATE SEX M M .O.B. 01 01 1990 39
INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS' AIRBAG,2 RESTR 4 EJECT '1 USE CLASS 1 ❑
41
21❑ LICENSE CPA 2867 TAre WA vIN# 3GNAXHEG6SL205033
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2025 MAKE CHEV MODEL EQUINOX STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO RENTAL HERTZ 18625 DES MOINES MEMORIAL DR SEATAC WA 98148 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO SEATTLE DOT SLEFIN 1 9TOP 5
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25❑ J s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG60724
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80777
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'
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 12-18-25 06:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/19/2025 12:35:03 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 6:14 AM TIME POLICE ARRIVED 8:09 AM
PART I PAGE IT]OF 4�
REPORT NO. EG60724 CASE# 25-80777 OF COLLISION
12/17/25 06:10
OF CbLLI510N
NARRATIVE
LANE 2 STOPPED GREEN LIGHT 2/BLK 1/WHT
RTF
Within the city limits of Renton/King/Wa I was dispatched for a phone follow up to a crash that
occurred at about 0614 hours at Maple Valley Hwy at Monroe Ave SE.
I contacted unit 2 driver by phone, who told me in summary: He was going to make an online report
which was approved by a supervisor at his place of employment. He was NB lane 2 MVH and though
his light was green traffic was stopped, including him, prior to the intersection. He told me while
stopped unit 1 swerve and contacted his vehicle striking the left rear portion of his vehicle. Unit 2 said
unit 1 hit with his right front portion. Unit 2 said there was no injury or damages that required a tow
truck. They did an informational exchange. However, Unit 2 was driving a leased work vehicle and a
second supervisor requested a police report. I provided the case number to unit 2.
1 contacted unit 1 driver by phone who identified himself as listed and that he was indeed the driver
and involved in a crash this morning. He provided the following in summary: He was driving to work
this morning in lane 2 and saw his light was green, but at the last minute realized traffic was stopped
in front of him. He swerved to avoid contact with unit 2 but contacted the back end of unit 2. He did
not complain of injury and damages did not require a tow truck. Traffic was heavy because of a mud
slide in the area from recent severe weather.
I explained to unit 1 that he did meet the requirements under RCW by making an information
exchange with unit 2 but unit 2 supervisor made a request for a police report. I provided the case
number to unit 1.
Information/insurance only
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 12/17/2025
PAGE 3 OF 4
REPORT NO. EG60724 CASE# ' 25-80777 DATE AND TIME 12/17/25 06:10
OF COLLISION
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