HomeMy WebLinkAbout23-4184 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED51839 170
27
COLLISION REP FIT 1591971
CASE 23-4184 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK NONE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 04 - 1-- 2023 1846 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BL
SW SUNSET BLVD
OCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFRAINIER AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255242425 0 81
30
6� LAST NAME YOUNG FIRSTNAME DONELLA MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 348 LIND AVE SW APT 26 CITY RENTON ST WA ZIP' 980575943 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BNE5962 sTArI WAurN# 1HGCG5652XA106772
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 3 1999 HOND ACCOR 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO THOMAS MC KENSIE348 LIND AVE SW33 RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 10BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 3AO095069,3AO095069 OP MOT VEH W/OUT INSURANCE,NO
15❑ STANDING 7 6
MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD M PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/
16 No ET D:2532669705
a
LAST NAME HAMMOND FIRST NAME CHERYL MIDDLE I L
INITIAL
17 STREET NEW ADDREs�' 725 KENSINGTON AVE S CITY KENT ST WA ZIP 980306234 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVER # STATE WA ]SEX IF M D.C.B. 12 _ 16 _ 1968 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE ❑21❑ PLATE It CHRIKET TArE 41
WA VIN1 19UU62F71FA023495 1
42
22❑ PIR LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEHICLE TOWED TO BLIN TOWEDeY GO HI 44
L4 VEH YEAR 2015 MAKE ACUR MODEL TLX STYLE 4D❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CHERYL HAMMOND 12402OLD SNOHOMISH MONROERD SNOHOMISH WA 98290 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I POLICY#E CO PEMCO CA1451108IN 1GD
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ALEKSANDRIGNATOV 12619 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED51839
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4184
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,FIRS 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 one was traveling eastbound on SW Sunset BLVD at Rainier Ave S in lane 3 of 4. Unit two was
stopped for a yellow light on SW Sunset BLVD at Rainier Ave S in lane 2 of 4. Unit one made an
abrupt unsafe lane change from lane 3 of 4 into lane 2 of 4 and struck unit two in the rear.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ALEKSANDR IGNATOV 04-13-23 08:18 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 411712023 4:24:18 AM
BADGE OR ID# 12619 ORI# WA0171300 TIME POLICE DISPATCHED 6:56 PM TIME POLICE ARRIVED:7:10 PM
PART I PAGE IT]OF 3�
REPORT NO. EU51839 CASE# 23-4184 DATE AND TIME 04/ 3/2318:48