HomeMy WebLinkAbout23-4654 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4654 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 04 - 1-- 2023 2201 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
S PUGET DR MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BENSON RD S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2063089887 0 81
30
6 LAST NAME CANCHOLA AGUIRRE FIRST NAME CESAR MIDDLE 1 2 31
INITIAL
STREET ❑, 1455 S PUGET DR#J304 CITY RENTON ST WA ZIP' 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ P1 ATNES# NONE sTAT vN# 1J4GA59189L775592
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR 6 2. TRLR 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2009 JEEP WRANG VT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO VERN FONK 2012460285 3 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv HIa.E 5 36
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2534579949
16 a
LAST NAME VELYCHKO FIRST NAME OSTAP MIDDLE
INITIAL
17❑ STREET ❑', 12902 SE 312TH#S201 CITY'AUBURN ST' WA ZIP 98092 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19[—] LDI IVER # STATE WA SEX U MMDDW 08 _ 04 2003 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CCF5862 TATe WA vIN# 5NPET46F39H456803
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GoI
VEH YEAR 2009 MAKE yyUN MODEL SONATA STYLE $D —FEHICLE
TOWED NOO✓ BLIN TOWED BY v HYES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 952675328IN 1 9TOP
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
G.BARFIELD 6476 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED55727
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4654
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'
On 4/25/23 at approximately 2223 hrs, I responded to a two vehicle non-injury, non-blocking collision
at the intersection of S Puget Dr and Benson Rd S in the city of Renton, King County, Washington.
Both vehicles had pulled into the parking lot of Teriyaki Wok on Benson Rd S.
I contacted both drivers who were the sole occupants of the two vehicles involved and confirmed that
there was no injury. I spoke to the driver of V1, Cesar Canchola Aguirre, who said that he was
stopped behind V2 when he saw the vehicle next to him start moving. Aguirre said that he assumed
that he could move and started forward, striking V2, who was still stopped for the signal, in the rear.
The driver of V2, Ostap Velychko, relayed the same information to me that he was stopped and his
vehicle was struck from behind by V1.
There was significant damage to the rear of V2 due to V1 have a large aftermarket welded bumper.
The driver of V1 said that there was no damage to his vehicle.
I provided both drivers with my card and the case number and explained what they needed to do
when they contacted their insurance companies. Both drivers had already exchanged information
prior to my arrival.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
G.BARFIELD 04-26-23 12:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/30/2023 5:02:01 AM
BADGE OR ID# 6476 ORI# WA0171300 TIME POLICE DISPATCHED 10:23 PM TIME POLICE ARRIVED f 10:25 PM
PART I PAGE IT]OF 3�
REPORT NO. ED55727 CASE# 23-4654 DATE AND TIME 04/25/23 22:01
OF COLLISION
1
S Puget Dr
Benson Rd S
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