HomeMy WebLinkAbout26-4415 TFFiNouCERA II I III 1 III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-4415 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 1 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 06 - 1-- 2026 1318 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 15300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES N EET e S ❑ E e 154TH PL SE
0 6 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2534077810 0 81
30
6 1❑ LAST NAME MAMADURASULOV FIRSTNAME NURASMAN MIDDLE 1 2 31
INITIAL
STREET ❑ 1590 134TH AVE SE APT C105 CITY BELLEVUE ST WA ZIP 98005 z
'NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs ,/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ L IIER # STATE yyq SEX'M I ELMM D Y' 07 — 14 — 2002 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 H USE CLASS
ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 1❑ P1 ATE 14 D68076D STATE WA u N# JALCDW160L7010559
11[-� TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 4 0 VIN#' VIN#'
:: FROM TO
VEH.YEAR 2020 CHEV 4500HD TR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34
13 4 DAMAGE YESNo YES[:] NO
REGISTERED OWNER INFO TRUCKRENTAL R.17850 WEST VALLEYHWY TUKWILA WA 98188 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ACE AMERICAN ISAH10846158 3 4
IN EFFECT &POLICY# 9TOP
VEH'C CHARGE 5 36
LEGALLY YES No CITATION# 6A0325695 FOLLOW VEHICLE TOO CLOSELY o Borrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLEi ❑ ❑ OWNER ❑ YES NO ,/
16 a D:4359012451
LAST NAME MAGEE FIRST NAME HUDSON MIDDLE S
INITIAL
17❑ STREET ❑', 81 BIG BEAR PL NW CITY' ISSAQUAH ST WA ZIP 98027 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NoF,/
19 D IVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CPA 9108 TATe WA VIN# 4S4BSAAC3H3430161
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2017 MAKE S'(JB�Q MODEL Q(J]'B/�C STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO,/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 01683 81 13UIN 1 GQ
VE""LE CITATION# CHARGE
LEGALLY YES Nu
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH14612
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4415
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 2 eastbound lane 2 on Maple Valley Hwy, stopped in traffic for red signal. Unit 1 eastbound on
Maple Valley Hwy, also in lane 2. Driver 1 Mamadurasulov told me that when he attempted to stop for
traffic at the red signal ahead of him, his fully loaded rental box truck was apparently too heavy to
stop in time, although he tried to apply the brakes as hard as he could. Unit 1 struck unit 2 front
bumper to rear bumper, directly from behind. Impact left two puntures in bumper skin from mounting
screws on unit 1's front license plate, and also left scratches on right half of bumper. I issued driver 1
an NOI for following too closely.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-07-26 02:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 6/23/2026 3:43:45 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED; 1:21 Pry] TIME POLICE ARRIVED?:Y8 Pry]
PART I PAGE IT]OF 3�
REPORTNO.! EH14612 CASE# 26-4415 DATE AND TIME 06/07/2613:18
OF COLLISION
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