HomeMy WebLinkAbout26-741 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG73691OLCERA
COLLISION REPORT 1591971
FIRE CASE#
26-741 2
INTERSTATE CITY STREET RESULTED ❑
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LQC'AI-AGENCY 4100 3
HIT&RUN ❑ CODING
COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 1❑ TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3n M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 01 - 26 - 2026 1920 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOBRONSON WAYNE MILE POST
e 1222 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1 MILES 1.1 FEET e S 8 W e
0 3 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE
❑ CYCLE ❑ YES No �/ D:4253460713 30
6❑ LAST NAME DANIYELYANTS FIRST NAME VLADIMIR MIDDLE t 1 2 31
INITIAL
STREET ❑ 3905 243RD PL SE UNIT M202 CITY; BOTHELL I ST; WA I Zip; 98021 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPQRTED 3
INTERLOCKYEs NO%/ INTERLOCKYEs No�/ YES NO
8❑ DRIVER # STATE WA SEXI M MMDDYY' 05 - ?7 - 1980 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY ? NATURE of INJURIES 2
10 PI ENSttEI BTR5820 STATE WA VIN# 3FADP4EJ8KM130474 3
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# 3 ROM
TRLR zRLR. 5 3 33
12 VIN#' IN
#
: FROM TO
VEH.YEAR ZOI9 MAKE FORD MODEL FIESTA STYLE SD VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 5 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDR/VER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILITY INSURANCE❑ NSURANCE CO
IN EFFECT &POLICY# 4TOP
vewc�e CHARGE t S 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ STM ING e
MOTOR PEDAL-:. PROPERTY DAM To OLD MET PHONE
UNIT( ❑ ' ❑ PEDESTRIAN Q✓ D:2154303405
VEHICLE CYCLE OWNER
YES NO
16�
LAST NAME DIEP FIRST NAME PHOLOT MIDDLE' N
INITIAL
17 F1 STREET ❑
❑ 14004 145TH AVE SE CITY RENTON ST, WA ZIP 98059 4 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
INTERLOCKYEs NO INTERLOCK YES NO YES NO
19 DRIVER'S STATE WA SEX M I D.O.B. 08 — 09 1981 39
LICENSE# MMDDYY —
6 INJURY 40
NATURE OF INJURIES 3
20❑ ON DUTY HELMET STATUS 3 AIRBAG' RESTR EJECT USE 2 CLASS 6 SCRAPPED KNEE,COMPLAINTS OF NECK PAIN ❑
21 PLATE# TATE VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 1 7 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
vemae ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NC
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MICAH BATTLE 12049 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG73691
COLLISION REPORT III III III III III 111
1591972 CASE# 26-741
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
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
On 1/26/26 at 1920 hours, I was dispatched to an injury Colliton at 1222 Bronson Way NE, in the City
of Renton, County of King, Washington.
Dispatched advised of a vehicle striking a pedestrian in the parking lot.
Upon arrival I spoke to Unit 1, who was identified as Vladimir Daniyelyants (5/17/80) who was driving
WA-BTR5820. He stated he had just gotten back from a parking spot and was making a right turn
from a stand still going less then 5mph when he struck Unit 2 on his driver side front bumper. Stated
he didn't see him util it was too late.
Unit 2, who was identified as Pholot Diep (8/9/81) stated he was walking in the roadway towards his
vehicle when Unit 1 struck him. I observed minor scratches too his right knee and he complained
neck pain. He was medically evaluated at the scene and chose to drive himself to the hospital later.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAH BATTLE 01-27-26 10:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
NICOLAS SANGDER 11350 113112026 10:48:57 PM
BADGE OR ID# 12049 ORI# WA0171300 TIME POLICE DISPATCHED; 7:21 PM TIME POLICE ARRIVED i 7:25 PM
PAST B a Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG73691 CASE# 26-741 DATE AND TIME 01/26/26 19:20
OF COLLISION
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