HomeMy WebLinkAbout23-14667 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14667 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 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#
cawsloN 12 - 1-- 2023 1753 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD PL BLOCK NO. e ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a RAINIER AVE S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2062263678 0 11
30
6� LAST NAME HASANULLAH FIRSTNAME SPED MIDDLE 1 2 31
INITIAL
STREET ❑ 13445 MARTIN LUTHER KING JR W UNIT F-202 C(Ty SEATTLE ST WA 2jp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CFE1697 sTArI WAvIN# 1NXBU40E29Z074666
TRAILER STATE TRAILER STATE11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[AWk GOVT.VEHICLE 34
13 4 2009 TOYT CAROLL SD DAMAG 3 7 E YES NO YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE STATE FARM 5291479E3047
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 10 BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 3A0852898,3AO852898 FAIL TO YIELD MOTOR VEHICLE,OP
15❑ STANDING 6
MOTOR PEDAL-:. OWNER PROPERTY DAM THR OLD MET PHONE
16
U VEHICLE CYCLE-02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES 1/ NO D:2062909506
a
LAST NAME DAVIDSON FIRST NAME NANCYLEE MIDDLE
INITIAL
17❑ NEW STREETR 7 11411 CRESTWOOD DR S CITY SEATTLE ST' WA ZIP 98178 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑NO� INTERLOCK YEs It I NOF YES
t l NOF
19 LDI ENS
IVERI # STATE WA SEX F M DDY
D.C.B.
10 _ 11 1946 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ LICENSE I PLA E# BIH8103 TArE WA VIN# 3GNCA13619S509640 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
N GI BANKERS YES No
VEH YEAR 2009 MAKE CHEV MODEL yHR SS STYLE UT IVEHI DAMAGE TO WED✓ OOBLIN TOWED BY OV 44
H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POLICY#E CO GEICO 0245-57-68-06IN 1 VEHICLe [:] CITATION# CHARGE
25 UQ,
LEGALLY YES N
7BEN
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M/N FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE37421
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14667
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.
BENJAMIN FLICK 12-22-23 02:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 11512024 6:06:03 AM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 5:55 PM TIME POLICE ARRIVED',6:08 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE37421 CASE# 23-14667 OF COLLISION12/21/23 17:53
NARRATIVE
23-14667
On 12-21-2023 at approximately 1755 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at the
cross of Rainier AVE S and S 3rd PL.
Upon arrival I made contact with both vehicles involved. The involved units and drivers were identified
as follows:
Unit 1 (WA/CFE1697) driver Syed Hasanullah (DOB: 02-08-2003 via WADL).
Unit 2 (WA/BIH8103) driver Nancylee Davidson (DOB: 10-11-1946 via WADL)
I contacted the involved parties and listened to their explanation of events, which were consistent with
each other.
Unit 02 was driving westbound on S 3rd PL, crossing the intersection of Rainier AVE S. Unit 02 had a
solid green light. Unit 01 was driving eastbound on S 3rd PL in the intersection, turning left to go
northbound onto Rainier AVE S. Unit 01 had a solid green light as well. Unit 01 then turned left, failing
to yield right of way to unit 02 in the intersection and collided with the driver side front quarter panel
area of unit 02.
1 provided both parties with a business card and case number.
I observed that the damage to the vehicles was consistent with what the parties had told me.
Driver Hasanullah had an insurance card, but it had expired in November of 2023.
1 asked both parties about injuries. Hasanullah denied injuries. Davidson did not report any injuries to
me.
At the conclusion of my investigation, I determined that driver Hasanullah had failed to yield right of
way at the intersection, colliding with unit 02 as a result. I confirmed with driver Hasanullah that his
DOL address was current. I informed him that he would be receiving a citation for failure to yield right
of way at an intersection and for not having insurance via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 12-21-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE37421 CASE# ' 23-14667 DATE AND TIME 12/21/23 17:53
OF COLLISION
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Not t0 scale
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3rd PL Unit 02
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PAGE 4 OF 4