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Home My WebLink About23-4734 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REPOFIT 1591971 23-4734 z CASE ❑ INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1❑ STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3❑HIT&RUN CODING COUNTY RD ❑ PRIVATE WAY ❑ INVOLVED 2 2g TOTAL#OF OBJECT 1 0 RESERVATION TRIBAL UNITS 03 STRUCK z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cowsloN 04 - 27 - 2023 0748 17 ❑-= S 8 IN e 1070 3❑ 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE PETROVITSKY RD BLOCK NO. e✓ --- ----❑ ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET ❑ S ❑ VV❑ 110THAVE SE 0 1 29 MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 9 30 6❑ LAST NAME PATINO GOMEZ FIRST NAME JUAN MIDDLE N 1 2 31 INITIAL STREET ❑ 10026 SE 238TH ST APT 12 CITy KENT ST WA 2jp, 980313266 z❑ NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3❑ iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ ❑ 10 9❑ pl ATFBit D88228A sTATI WA urN# 1GCGTDEN6H1304635 3 TRAILER STATE TRAILER STATE11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE J 9 34 13 2 2017 CHEV COLOR DAMAGE YES NOBS YES : No✓ REGISTERED OWNER INFO A.MORA MORA 3272239THAVE S FEDERAL WAYWA 98001 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 ABILI V INSURANCE INSURANCE CO SAME. <1�3g 4 IN EFFECT &POLICY#❑ LEGA LE CHARGE 36 15 2 VEHNYES❑No❑ clTAnoN# 3A0329656 INATTENTIVE DRIVING UNIT MOTOR Z PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ ET PHON DAM THR OLDME 1 VEHICLE CYCLE OWNER YES�/ NO 16❑ LAST NAME MOHAMED FIRST NAME FATHA MIDDLE JA INITIAL 17❑ STREET ❑', 11100 SE PETROVITSKY RD#L 101 CITY' RENTON ST WA ZIP 98055 37 NEW ADDRESS ❑ 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38 INTERLOCK YEs❑INOR INTERLOCK YEs I I No� YES t l No❑) 19❑ LDICENS STATE WA SEX U M .C.B. 01 ❑ 01 1990 ❑ 39 HELMET I {NJURY NATURE OF INJURIES 40 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21❑ LICENSE I BXD0627 TATe WA 5YFBURHE5JP852675 ❑ 41 PLATE# 22❑ PLATE# STATE PLATE# 42 STATE ❑ 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2018 MAKE TOYT MODEL COROLL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO FATHA MOHAMED 11100SEPETROVITSKYRD#L101 RENTON WA 98055 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. I 9TOP "'""LE YEs❑ N❑ CITATION# 3A0329657,3A0329657 CHARGE NO DRIVER'S LICENSE ON PERSON, , 25 o BOTTOM LY s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED55401 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4734 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 04-27-23 09:40 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 412812023 2:56:35 PM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 7:49 AM TIME POLICE ARRIVED',8:00 AM PART I PAGE IT]OF REPORT NO. ED55401 CASE# 23-4734 OF COLLISION 04/27/23 07:48 OF CbLLI510N NARRATIVE 3/WHT TRK LANE 2 WB 2 WHT TOY STADL LT HIT BY UNIT 1 GRY TRK CC Within the city limits of Renton/King/WA I responded to a 3 car blocking unknown if injury crash at the intersection of SE Petrovitsky Rd at 110th Ave SE. I contacted the driver of unit 3 who told me she was stopped westbound lane 2 for morning commuter traffic. She told me that unit 2 was stopped with her car in both eastbound lane 2 and the 2WCLTL waiting to make a left turn. She told me that it appeared as if unit 1 was speeding and just crashed into the back of unit 2, which cause his vehicle to divert and hit her car head on. She did not complain of injury and damages did require a tow truck. I contacted the driver of unit 2 who told me she was trying to make a left turn but did not fully describe her lane position when she was hit from behind by by unit 1. She did not complain of injury and damages required a tow truck. Renton Fire did check her as a precautionary. She did not provide information for her passenger. She did not have her drivers license or registration for her vehicle. A WACIC/DOL check via MDC revealed the information she provided did match her DOL. I contacted the driver of unit 1 ID'd by picture WADL. He told me he didnt speak very much English and crashed into the back of unit 2. He did not provide any other information, only his documents. He did not complain of injury and damages did not require a tow truck. I cited unit 2 Ref RCW 46.20.017 fail to carry drivers license and Ref RCW 46.61.140 improper lane use by not getting into the 2WCLTL fully before stopping to make a left turn contributing to the crash via complaint. I cited unit 1 Ref RMC 10-12-25 Driver Inattention 3 car 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 4/27/2023 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. ED55401 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-4734 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GINAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YEs NO 5 VEHICLE CYCLE OWNER ✓ 0 7 29 LAST NAME STROPPA FIRST NAME ERIN MIDDLE'.. E INITIAL STREET 30 NEW AnDRFSP 16519 116TH AVE SE CITY RENTON ST WA ZIP 980585240 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTEO 1 1 2 31 INTERLOCK YEs No NTERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv', 03 - 28 - 1983 7 ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET INJURY 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE K170317 TAT TX VIN# 1GCHSCEAXN1220795 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2022 MAKE CHEV I MODELCOLORA STYLE VEHICLE TOWS E T SABLI "WED BY anvi vFH1G P FROM TO DAMAGE YES✓NO YES NO ✓ 33 REGISTERED OWNER INFO USIC SERVICES LLC 1933 WESTRIDGE DR IRVING TX 75038 J 9 SHADE IN DAMAGED AREA 12 7 j 4 FROM TO INSURANCE CO LIABILITY INSURANCE SAME. m 34 IN EFFECT &POLICY# 13 LEGALLY LE ❑ CITATION# CHARGE 0 BOTTOM LEGALLY YES NO STANDING } l:9 dg 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME INITIAL 36 MIDDLE ❑ STRE 16 NEW ETETnnR"Fl CITY ST ZIP CDL IGNITION REdUiREO IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE ICLASS 19 ❑ 39 LICENSE rnr vIN# PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LecALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. X LEVERTON 04-27-23 09:40 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 2517 O#IL WA0171300 JOHNSON 412812023 PAGE F OF 5 3000-345-013(R 11118) REPORT NO. ED55401 CASE# 23-4734 DATE AND TIME 04/27/23 07:48 OF COLLISION nts i or PAGE 5 OF 5