HomeMy WebLinkAbout23-1303 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. ED30439 170
27
COLLISION REP FIT 1591971
CASE 23-1303 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 400 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 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 01 - 1-- 2023 0717 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BRONSONWAYNE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4258664994 0 11
30
6� LAST NAME WILSON FIRSTNAME ALEXANDER MIDDLE R 1 2 31
INITIAL
STREET ❑ 11056 NE 14TH ST CITY BELLEVUE ST WA 2jp, 980043725 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� D22444B sTArI WA urN# 1FTPX14564N688313
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 3 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2004 FORD F150 DAMAGE vEs ONO f �AWkkRS vEs❑ No✓
REGISTERED OWNER INFO ALEXANDERWILSON 407INDEX PL NE RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6089 91 61 98 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv HICLE 5 36
res❑NO❑ CITATION# 3A0081023 CHARGE FAIL STOP AT STOP )o BOTTOM
STAIN.D'ING 8 7 6
UNIT VEHICLE IMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWNER RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME GRIGORIYCHUK FIRST NAME LYUBOV MIDDLE N
INITIAL
17❑ STREET ❑', 14407 SE 258TH PL CITY' KENT ST WA ZIP 980423627 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 DRIVER #
INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 USE CLASS RIBS FACE
21❑ LICENSE I BPV2301 TAre WA VIN# 1GNSKBKC4FR543045
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2015 MAKE CHEV MODEL TAHOE STYLE I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO CHAD SAKUMA 14407 SE258THPL KENTWA980423627 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO pEMCO TBAIN 9TOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL to BOTTOM
LY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED30439
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1303
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 01-31-23 08:13 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 2/1/2023 4:55:15 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:99 AM TIME POLICE ARRIVED',7:24 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED30439 CASE# 23-1303 OF COLLISION01/31/23 07:17
NARRATIVE
gry truck/unitl It bronson maroon tahoe/2 nb
CC
Within the city limit of Renton/King/WA I responded to a 2 car blocking at Sunset Blvd NE at Bronson
Way NE.
I contacted the driver of unit 1 ID'd by his picture WADL, who said he was making a left turn from
Bronson Way NE onto Sunset and told me he couldn't see unit 2 because of his blind spot. He drove
into the front and side of unit 2. He did not complain of injury and damages did require a tow truck.
I contacted the driver of unit 2 who told me she was just going straight on Sunset when unit 1 crashed
into her. She complained of face and rib pain as well as nausea. Renton Fire treated her on scene.
Her vehicle was towed for damages. She was transported by Renton Fire to VMC-ER for further
checks.
I cited unit 1 ref RCW 46.61.190 FTYROW-stop sign two car injury 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 1/31/2023
PAGE 3 OF 4
REPORT NO. ED30439 CASE# ' 23-1303 DATE AND TIME 01/31/23 07:17
OF COLLISION
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