HomeMy WebLinkAbout23-3650 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3650 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 03 - 1-- 2023 1313 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 350
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FEET MILES e S ❑ W e LIND AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253068151 0 11
30
6� LAST NAME CHEPURKO FIRSTNAME SERGEY MIDDLE G 1 1 2 31
INITIAL
STREET ❑, 51504 MOUNTAIN HWY E CITY' EATONVILLE ST I WA Zjp, 983289431 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 9❑ pj ATE 14 AGH9547 STATE WA u N# 1J4HR58235C636052
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2005 JEEP GRAND DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO RICHARD MARSHALL 5150 INDEPENDENCE PL SW PORT ORCHARD WA 98367 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
VEHCLE CHARGE 10 BOTTOM 36
LE�ALLv YES No CITATION# 3A0081116,3A0081116 FAIL YIELD LEFT TURN MOTOR
15❑ 1ND'ING 8 7 6
MOTO UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ )WNFRRT ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME RIGGS FIRST NAME CHANCE MIDDLE N
INITIAL
17❑ STREET ❑', 28319 229TH PL SE CITY MAPLE VALLEY ST WA ZIP 980388149 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'S STATE WA SEX M D.C... O6 _ 25 _ 1996 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BDV8121 TATe WA vIN# 19VDE2E56EE000675
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2014 MAKE ACUR MODEL ILX STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO JERRYRIGGS 28319229TH PL SE MAPLE VALLEY WA 98038 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED48310
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3650
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'
drk grn suv left turn across eb 43 gry sedan lane 1
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash near the 350 block of
SW 43rd St. Both cars were able to move and clear the roadway.
I contacted the driver of unit 2 who said he was eastbound lane 1 on 43 when unit 1 turned left in front
of his car without enough space to avoid contact. He did not complain of injury and damages did not
require a tow truck.
The driver of unit was said he was going to make a left turn from westbound 43 towards a parking lot.
Traffic was stopped in lane 2 and he proceeded to make his left turn without clearing traffic in lane 1,
crashing into unit 2. He did not complain of injury and damaged did not require a tow truck.
Unit 1 was cited via complaint ref RCW 46.61.185 FTYROW-Left turn 2 car cash and RCW
46.30.020, unit 1 was unable to provide valid proof of insurance for his vehicle.
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 3/31/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-31-23 01:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 4/4/2023 9:49:33 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 1:14 PM TIME POLICE ARRIVED 1:16 PM
PART I PAGE IT]OF
REPORTNO.! ED48310 CASE# 23-3650 DATE AND TIME 03/31/2313:13
OF COLLISION
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