HomeMy WebLinkAbout23-8983 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-8983 2 6 0
INTERSTATE CITY STREET 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
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 08 - 1-- 2023 1720 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SR167 BLOCK NO. e✓ 799 ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W HF j GgApyWAy
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2065384115 0 7 30
6� LAST NAME QAHER FIRSTNAME AMANULLAH MIDDLE N
INITIAL 1 2 31
STREET ❑ 510 STEVENS AVE SW APT R401 CITY RENTON ST WA 7jp, 980575881 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 1❑ P1 LICENE 14 CET9921 sTAr WAu N# 19XF62F51 DE268569
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#'
FROM TO
VEH.YEAR 2013 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 9 34
13 4 HOND ClV4D DAMAGE YES NO YES[:] ✓
REGISTERED OWNER INFO AMANULLAH DAHER13445 MARTIN LUTHER KING JR W SEATTLEWA98178 D:2065384115 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2019524562 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LE—Lv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063563594
16 a
LAST NAME DE FIRST NAME GUZMAN MIDDLE I L
INITIAL
17 STREET❑ NEW ADOREss❑' 51 ALBION ST APT AA CITY MELROSE ST MA ZIP 021761861 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVERS#
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# A/V0547 TArE 41
WA VIN# 1NXBR12E81Z471963 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2009 MAKE TOYT MODEL COROLL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO STACY REYNOLDS 5204 W HIGHLAND RD EVERETT WA 98203 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04121738613IN I GQO,
VEHICLE CITATION# CHARGE
25❑ LLY
LEGA YES[Z NC[:] s e
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# TZ01Y71300
NC
26
TAGNE 12575
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED87449
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8983
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CHAN PIK S
(IAST FIRST,
ADDRESS&PHONE#
129 4TH ST NONE MEDFORD MA 021555017 2063563594 SEXi F MMDOYyry 02 - 15 - 1984
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER RWITNESS R'UNIT# 2 POS 8 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 17 NECK PAIN
NAME
'(LAST,FIR MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY -
PASSENGER ❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
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.
P.LANTAGNE 08-06-23 06:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 8/8/2023 4:49:28 PM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED; 5:21 PM TIME POLICE ARRIVED',5:23 PM
PART I PAGE IT]OF 4�
REPORT NO. ED87449 CASE# 23-8983 OF COLLISION
08/06/23 17:20
OF CbLLI510N
NARRATIVE
23-8983
On 08/06/2023 at approximately 1721 hours, I, Officer Lantagne, responded to a non-blocking,
possible injury collision near the intersection of SR167 and S Grady WAY, which is located in the City
of Renton, County of King, and the State of Washington. I responded in my fully marked police
vehicle, wearing my patrol uniform.
I arrived on scene and observed Unit#1, a 2013 Honda Civic with license plates CET9921 issued out
of Washington State, and Unit#2, a 2001 Toyota Corolla with license plates AIV0547, parked in an
empty lot to the north of the intersection. The female passenger of Unit#2 advised she had slight
neck pain and was evaluated by the Renton Fire Department.
I contacted the driver of Unit#1, Amanullah Qaher (DOB 12/17/1997), who told me the following:
Qaher was driving northbound on SR167. As Qaher's vehicle approached the intersection at S Grady
WAY, he thought his light was green and continued forward. Qaher realized the left turn light was
green and not the straight thru lane and attempted to stop his vehicle. The front of Qaher's vehicle hit
the rear bumper of Unit#2.
1 contacted the driver of Unit#2, Guzman L. De (DOB 10/12/1984), who told me the following: De was
stopped at a red light facing northbound on SR167 at the intersection of S Grady WAY in the left thru
lane. Before the light turned green, the rear of De's vehicle was hit by Unit#1.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had minor scrapes on the license plate bracket. Unit#2 had
minor plastic scrapes on the rear bumper and flex cracks in the paint clear coat.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Qaher and De.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1829 hours on 08/06/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. ED87449 CASE# ' 23-8983 DATE AND TIME 08/06/23 17:20
OF COLLISION
Rainier Ave. S
S Grady Way
SW Grady Way
.ee I B
"
E
Unit #2
Case #23-8983
QM Unit #'1
Not to Scale HWY 167'
P. Lantagne #12575
PAGE 4 OF 4