HomeMy WebLinkAbout24-1325 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-1325 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION 02 - 1-- 2024 0650 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE PETROVITYSKY RD
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 110TH LN SE
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 7 30
6� LAST NAME RODRIGUEZ FIRSTNAME ALEX MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 17333 121 ST LN SE APT 11-303 CITY RENTON ST WA 2jp, 98058 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CFF0985 sTArI WAurN# WVWHD7AJ4EW007853
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2014 VOLK GTI DAMAGE vEs ONO agW�MEYER vEs❑ No
REGISTERED OWNER INFO ALEX RODRIGUEZ 17333121ST LN SE APT II-303 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE to BOTTOM 5 36
LEGALLY YES NO CITATION# 4A0078013,4A0078013, FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 7 6
�UITN 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES�/ NO OLD MET PHONE
16 a
LAST NAME MANTILLA FIRST NAME MONINA MIDDLE I L
INITIAL
17❑ STREET ❑', 17515 118TH AVE SE APT B5 CITY RENTON ST WA ZIP 980586098 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t t— l NO❑
19F] DRIVER'S STATE WA SEX F D.Q.B. O6 �_ 08 _ 1937 39
LICENSE# MMDDYY
WELMET INJURY NATURE OF INJURIES 4O
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CDL0746 TAre WA VIN# 19UUA66247A025578
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2007 MAKE ACUR MODEL TL STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO MONINA MANTILLA 17511118THAVESEAPT85 RENTON WA 98058 D:4259992728 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE INSU POLICY#E CO SAME.IN 9TOP
VE"'LE CITATION# CHARGE
YES N
25 to BOTTOM
LEGALLY u
❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE50264
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1325
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 02-06-24 11:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 2/14/2024 10:45:16 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED', 6:51 AM TIME POLICE ARRIVED',6:56 AM
PART I PAGE IT]OF 5�
REPORT NO. EE50264 CASE# 24-1325 OF COLLISION
02/06/24 06:50
OF CbLLI510N
NARRATIVE
blk 1 rear stopped slv 2 slv 3
CC
On 2/6/2024 at about 0650 hours within the city limits of Renton/King/WA I responded to a 3 car
blocking crash at SE Petrovitsky Rd and 110th Ave SE.
I contacted the driver of unit 3 who told me he was stopped westbound lane 1 when he was hit from
behind. He did not complain of injury and damages to his truck appeared unremarkable.
I contacted the driver of unit 2 who told me she was stopped behind unit 3 when she was hit from
behind by unit 1 and that shoved her into unit 3. She did not complain of injury and damages did
require a tow truck.
I contacted the driver of unit 1 verbally ID'd as Rodriguez, Alex D 05262003. A WACIC/DOL check
revealed unit 1 was DWLS 3rd. He did not provide any form of ID. DOL picture matched. He was
unable to provide insurance for his vehicle. He told me he could not stop in time and crashed into the
back of unit 2 pushing her into unit 3. He did not complain of injury and damages did require a tow
truck.
I cited Rodriguez/unit 1 ref RCW 46.61.145 Following too close 3 car crash, RCW 46.20.017 Fail to
carry ID on person, RCW 46.30.020 No valid proof of insurance and RCW 46.20.342 Driving While
Suspended Third Degree 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 2/6/2024
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE550264
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-1325
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD 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 DANYLUK FIRST NAME JOHN MIDDLE' ',, D
INITIAL
STREET 30
NEW AnDRFSP' 17310 158TH AVE SE CITY RENTON ST WA ZIP 980589157
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No NTERLOCK YES�NO� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 06 TO]
- 1961
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE D08574D [TAT WA VIN# 3TMDZ5BN4PM152660
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2023 MAKE TOYT MODELTACOMA STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1G P FROM TO
DAMAGE YES NO ✓ YES NO ✓
33
REGISTERED OWNER INFOJOHN DANYLUK 17310158TH AVE SE RENTON WA 98058 D:4695149845 J 9
SHADE IN DAMAGED AREA
12 7 j 4 FROM TO
INSURANCE CO
((ABILITY INSURANCE SAME. 34
IN EFFECT &POLICY#13VEHICLE ❑ CITATION# CHARGE GQO
LEGALLY YES NO
STANDING S} 8 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNER YE
YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK 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 (CLASS
19 ❑ 39
LICENSE VIN#
PLATE# rnr
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
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 LERICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGAtty
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 02-06-24 11:02 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
BADGE,.. O#I' APPROVED %
ORID# 2517 WA0171300 BS 2 FOF26
3000-345-013(R 11118)
REPORT NO. EE50264 CASE# 24-1325 DATE AND TIME 02/06/24 06:50
OF COLLISION
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PAGE 5 OF 5