HomeMy WebLinkAbout23-1847 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-1847 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 5 1 28
TRIBAL 1 OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 02 - 14 - 2023 1522 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EDMONDS AVE NE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ We NE7THST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255036885 0 11
30
6� LAST NAME BUN FIRSTNAME MARKRA MIDDLE N 1 2 31
INITIAL
STREET ❑ 3517 NE 10TH ST CITy RENTON ST WA ZIP 980563518 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YEs No✓
8❑ DRIVERS
# STATE WA SEX'M I D-MIDI Y' 01 - 05 - 1957 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM
U EET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 2❑ pl ATE 14 BFH4867 STATE WA V N# 2HGES26762H587563
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 1 5 33
12 2 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR I MAKE I MODEL STYLE VEHICLE TOWED fn TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 2002 HOND ClV4D 4D DAMAGE YES NO ✓ YES❑ NO✓
REGISTERED OWNER INFO MARKRA BUN 3517 NE 10TH ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PEMCO CA 1563545 EXP 10.23
IN EFFECT &POLICY# 9TOP
VEHICL' CHARGE 1 5 35
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D" 8 6
UNIT VE IOOR CYCLE ❑ PEDESTRIAN ❑ OWNER RTY ❑ DYES✓ NO OLDMET PHONE
16 a
LAST NAME KASPAROV FIRST NAME RAFIK MIDDLE N
INITIAL
17 STREET❑ NEW ADOREss❑' 15520 NE 11 TH ST APT B301 CITY BELLEVUE ST WA ZIP 980074677 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.O.B. 07 28 _ 1947 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ ILICENSE PLA E# BJ66571 TATE WA VIN# 1LNHM81W85Y656119 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2005 MAKE LINO MODEL TOWN STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO✓ YES NO✓
REGISTERED OWNER INFO LILIANA KASPAROVA 12150TH PL NE BELLEVUE WA 98007 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#ECO NATIONWIDE 7246JO05107EXP5-23 STOP 5
IN EFFECT
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL to BOTTOM
0(
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52748
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1847
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) XASPAROVA ARM/DA N
(/AST FIRST,
ADDRESS&PHONE# D O.B.
15520 NE 11TH ST APT B301 BELLEVUE WA 980074677 SEXi F MMDDYyYv 02 - 19 - 1954
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. 3 2 4 1 USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# BEd MMDDYYYY DOB
PASSENGER []WITNESSO UNIT# : SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 2-14-23 at about 1531 1 arrived at the intersection of NE 7th St and Edmonds Ave NE for a 2
vehicle collision. I contacted both vehicles and drivers near the intersection. Both drivers identified
themselves via WADL. Driver 1, Markra Bun told me; He was Northbound through the intersection
and did not see unit 2 as he proceeded through the intersection. As he drove trhough the intersection
unit 2 collided with the rear quarter panel of his vehicle. Driver 2, Rafik Kasparov told me; He was
westbound through the intersection when unit 1 just appeared in front of his vehicle and they collided.
Both veicles were leaving from stop signs. There are no independent witnesses to the collision. Both
vehicles were released to the drivers.
This collision occurred in the city of Renton, County of King.
I declare under penalty of perjury under the laws of Washingotn state that the foregoing is true and
correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 03-08-23 09:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1 411912023 7:04:16 PM
BADGE OR ID# 1953 OR]# WA0171300 TIME POLICE DISPATCHED 3:26 PM TIME POLICE ARRIVED 3:31 PM
PART I PAGE IT]OF
REPORT NO. ED52748 CASE# ' 23-1847 DATE AND TIME 02/14/23 15:22
OF COLLISION
NOT DRAWN TO SCALE
PAGE 3 OF 3