HomeMy WebLinkAbout23-7055 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-7055 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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 - 1-- 2023 1425 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 18100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255247132 0 81
30
6� LAST NAME FOSTER FIRSTNAME LUKAS MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 17815 105TH PL SE APT L 102 CITY RENTON ST WA ZIP 980558418 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CFN8140 sTArI WAurN# JHMC67662MC009989
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 4 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 1991 MAKE HOND MODEL ACD4D STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO JENNIFERHURLEY4600DAVISAVESAPTT101RENTONINA98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
3 4
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VE—LL CHARGE IOR TTOM 5 36
LEGALLY YES No CITATION# 3A0387737,3A0387737, NO VALID OPER LICENSE WITH
15❑ STANDING 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U—NIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069797122
16 a
LAST NAME MONUSZKO FIRST NAME CHARLENE MIDDLE A
INITIAL
17❑ STREET ❑', 9844 S 262ND PL CITY' KENT ST WA ZIP 980307679 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BUY6069 TAre WA VIN# KM8R5DHE6LU104744
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE HYUN MODEL PALISAD STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO GARY MONUSZKO 9844 S 262ND PL KENT WA 98030 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU8 PORGY#E CO SAFECO INS H893170IN 1 9TOP
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76147
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7055
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MONUSZKO TANYA R
(LAST FIRST,
ADDRESS&PHONE# D O.B.
KENT SEX F MMDDYYYY 06 - 28 - 1978
PASSENGER Z WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE CLASS
!1
NAME
(LAST,FIRST,MIDDLE INITIAL) : MONUSZKO BRANDON
ADDRESS&PHONE# D Q B
KENT SEX M MMDYVYY 10 _ O6 _ 1984
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER Z WITNESS UNIT# 2 PCS 4 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 062123 1 responded to a 2-vehicle non-injury/non-blocking collision at the 18100 block of
NORTHBOUND 108th Ave SE.
I contacted the driver of unit 2 who told me they were stopped for traffic in the #2 lane of 108th Ave
Se when they were hit from behind by unit 1. The driver was not injured. Two passengers in unit 2
were also uninjured. Unit 2 sustained rear bumper damage.
I contacted the driver of unit 1, identified as Lukas Foster (dob 06-23-04) via his WA ID. Foster says
was giving a thumbs up to the driver of a vehicle he noticed because it looked nice. As he was doig
that and looking at the vehicle, he rear-ended unit 2. Foster was not injured. His vehicle sustained
front end damage but was drivable.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Foster via SECTOR under RCW 46.20.015.180.1 -NO VALID OPERATORS LICENSE
W/VALID ID, RCW 46.30.020 -OPERATING A MOTOR VEHICLE WITHOUT INSURANCE, RMC 10-
12-25- INNATENTIVE 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 06-21-23 03:58 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 7/3/2023 3:13:41 PM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 2:25 PM TIME POLICE ARRIVED 2:30 PM
PART I PAGE IT]OF 3�
REPORT NO. ED76147 CASE# ' 23-7055 DATE AND TIME 06/21/23 14:25
OF COLLISION
108th AVE SE Z"
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