HomeMy WebLinkAbout23-6226 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6226 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 06 - 01 - 2023 1620 17 ❑.❑ S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FEET e S ❑ W e WHITMAN CT NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:3127789020 0 6 30
6� LAST NAME FILIPPOVA FIRSTNAME VLADA MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 13403 NEWCASTLE COMMONS DR AP CITY NEWCASTLE ST WA 2jp, 980593220 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 2 RESTR 4 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� CEV7364 sTATI WAvIN# 5XYPG4A3XGG185012
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 20,16 MAKE KIA MODEL SORENT STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO VIA.FILIPPO.13403 NEWCASTLE COMMONS DR AP NEWCASTLE INA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 965382383 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 3A0387728 INATTENTIVE DRIVING <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- :PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES V No D:4252465795
16 a
LAST NAME BARRERA MALDONADO FIRST NAME GABINO MIDDLE N
INITIAL
17❑ STREET ❑', 3612 NE 4TH ST TRLR 24 CITY RENTON ST WA ZIP 980564188 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO❑ 11
19 D IVEW # STATE WA SEX M MMDDW 03 _ 14 1968 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C77177W TATe WA vIN# 1C6RR7JTXES410578
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2014 MAKE RAM MODEL 1500 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EDGAR BARRERA MENDOZA 3612 NE 4TH ST TRLR 24 RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE❑ INSU PORGY#E CO GEICO INS 4307 02 5876IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED67202
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6226
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 060103 at approximately 1630 hours I observed a 2-vehicle non-injury/non-blocking collision at
NE 4th and Whitman Ct NE.
I contacted the driver of unit 2 who told me they were in the #2 lane of westbound NE 4th and slowing
for traffic when they were rear-ended by unit 1. Driver states he was not injured. His vehicle
sustained some rear bumper damage.
I contacted the driver of unit 1 identified Vlada Filippova (dob 12-25-96) via her WA DL. Filippova
was traveling behind unit 2 and rear-ended that vehicle. Filippova's vehicle, although she was
traveling at a low rate of speed (less than 15mph), sustained heavy front-end damage. She was not
injured.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Filippova via SECTOR under RMC 10-12-25 -Inattentive Driving
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-02-23 10:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/5/2023 2:26:27 PM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 4:Y0 Pry] TIME POLICE ARRIVED',4:20 PM
PART I PAGE IT]OF 3�
REPORT NO. ED67202 CASE# ' 23-6226 DATE AND TIME 06/01/23 16:20
OF COLLISION
Union Ave NE
N
NE 4th St
PAGE 3 OF 3