HomeMy WebLinkAbout22-13489 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 22-13489 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 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#
COLLISION.. 12 - 1-- 2022 1539 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EASTVALLEYRD BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ w SW4IST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532469750 0 11
30
6 LAST NAME MUSA SALIH FIRST NAME ABDALZIZ MIDDLE M 1 1 2 31
INITIAL
STREET ❑1 21014 109TH PL SE APT 927 CITY KENT ST WA Zjp, 980311371 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs No�/
8❑ LICENSE# STATE Wq SEX'M M LOB 01 1993 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CEJ8914 sTArI WAurN If JTDKARFU4H3036000
10❑ PI ATE 14
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 2 2017 TOYT PRIUS DAMAGE vE6 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO ABDALZIZMUSA S.41.10929110THAVE SEAPT 1525 KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO NATIONWIDE 7246JO70982 3 4
IN EFFECT &POLICY# 9TOP
vEHICLE CHARGE 5 36
ECALLY res No CITATION# 2A0561210 VEH ENTER INTERSEC STEADY RED o sorrow
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066377682
16 a
LAST NAME CARDINES FIRST NAME MELVIN MIDDLE D
INITIAL
17❑ STREET ❑', 1320 23RD ST SE CITY AUBURN ST WA ZIP 98002 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 11 02 _ 1983 39
LICENSE# MMDDYY
El
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE 2 CLASS LEFT SIDE PAIN ❑
21❑ LICENSE I CBE1357 TAre I WA VIN# 5FNYF6H63N6005103
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2022 MAKE HOND MODEL PILOT STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO MELVIN CARDINES 132023RD ST SE AUBURN WA 98002 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO PROGRESSIVE 922356525IN STOP 5
VEHICLE ,.I— #I CITATION CHARGE
25 i o BOTTOM
LEGALLY YES❑ N
' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED19081
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13489
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 1 was traveling southbound on East Valley RD approaching a traffic signal at SW 41 st ST. Unit
2 was traveling eastbound on SW 41st ST approaching the traffic signal at East Valley RD. Driver 2
states that he had a green light and noted it had been green for at least 3 seconds. Driver 1 stated he
did not see the light and had no recollection of the light color. Based on these two statements, Unit 1
entered the intersection against the red traffic signal as Unit 2 was traveling through it lawfully. The
front passenger corner of Unit 1 struck the front driver's corner of Unit 2 causing heavy damage to
both vehicles. Both vehicles towed by Bankers Tow.
Driver 1 cited for entering an intersection against a steady red circle (red light) which was the
proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 12-21-22 10:48 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 12/27/2022 1:09:23 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 3:41 PM TIME POLICE ARRIVED',3:44 PM
PART I PAGE IT]OF
REPORT NO.! ED19081 CASE# ' 22-13489 DATE AND TIME 12/20/22 15:39
OF COLLISION
s
N
m
***NOT TO SCALE***
SW 41 ST ST
3
i
3
3
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