HomeMy WebLinkAbout23-6481 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6481 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#
CawsloN 06 - 1-- 2023 0646 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE CARR RD MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 108THAVESE
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO ✓ D:2067782820 0 4 30
6� LAST NAME ALEMAYEHU FIRSTNAME ZEWDITU MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 320O S 176TH ST APT 204 CITY SEATAC ST WA Zjp, 981884009 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I iNTERLOCKYEs No NTERLOCKYEs 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 aTES� RS13947 sTArI WAvIN# 1FDFE4FS6KDC32153
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 3 2019 FORD ECONO DAMAGE YES NO ✓ YES : NO✓
REGISTERED OWNER INFO KING COUNTY ACCESSIBLE SERVIC 5004THAVERM 620MSADM-ES-62 SEATTLE WA 98104 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO SELF INSURED 4
LI EFFECT I POLICY# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2067156370
16 a
LAST NAME TEKESTE FIRST NAME SIMON MIDDLE N
INITIAL
17 STREET I5❑' 17023 106TH AVE SE CITY' RENTON ST WA ZIP 980555430 4❑ 37
NEW ADORE5
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] LDI IVEW # STATE WA SEX M M D.O.B. O6 _ 16 _ 1978 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# ATH6428 TArE WA VIN# 41
JTDKN3DU8F0408991 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE TOYT MODEL PRIUS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO SIMON TEKESTE 17023106TH AVE SE RENTON WA 98055 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU8 POLICY#E CO PEMCO CA1415251IN 1U�VE""LE
TOP❑ ,J� CITATION# CHARGE TTOMLGALYYES N`L J25 '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26
ALEKSANDR IGNATOV 12619
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED69284
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6481
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'
Unit one was traveling westbound on SE Carr Rd in the left turn lane. Unit one was making a left hand
turn northbound onto 108th AVE SE. Unit two was in front of Unit one also making a left hand turn
northbound on 108th AVE SE. Traffic slowed down and Unit one lightly struck unit two in the rear
causing minor damage.
Unit one uploaded video footage from her vehicles dash cam into Axon Evidence. I took photos of the
damage and uploaded the photos into Axon Evidence.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ALEKSANDR IGNATOV 06-08-23 01:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.SKELTON 9139 611212023 3:57:14 AM
BADGE OR ID# 12619 ORI# WA0171300 TIME POLICE DISPATCHED 6:49 AM TIME POLICE ARRIVED 6:54 AM
PART I PAGE IT]OF 3�
REPORT NO. ED69284 CASE# 23-6481 DATE AND TIME 06/07/23 06:46
OF COLLISION
108th AVE SE
1 .
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d
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