HomeMy WebLinkAbout23-9224 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9224 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: 08 — 1—— 2023 1723 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET e S B W e GRADYWAYS
0 2 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:2067863608 N:2069736205 0 11
30
6❑ LAST NAME NUR FIRSTNAME IKRAM MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 3602 S 180TH CITY SEATAC ST WA 2jp, 98188 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 1- 15 - 2001 2 32
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 . EJECT 1 HELMETU E 2 CLASS INJURY5 [NATURE OF INJURIES
BACKAND LEG PAIN z❑
3
10 9❑ P1 ATE BWB7634 STATE WA VIN# 4T1M11BKfl0004120
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 2 2020 TOYT CAMRY SD DAMAGE vES 0NO agW�MEYERS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 912P
VEHICLE CHARGE 5 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:4259194437 N:4255163282
16 a
LAST NAME FELICIDAD FIRST NAME MARYANN MIDDLE N
INITIAL
17 STREET I❑ 1815 LAKE YOUNGS WAY CITY' RENTON ST WA ZIP 98058 37
NEW ADDREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 F] DRIVER'S STATE WA ]SEX IF D.C... 07 26 _ 1968 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# 343YN0 TATE WA VIN# 41
JTDBL40E199070151 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2009 MAKE 7'Dy7' MODEL CORO!! STYLE $D —FEHICLE
TOWED✓ NOO BLIN GENE MEYERS YES NO�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO PEMCO CA0693267IN 9TOP 5
VE""LE ❑ Nu
J,J� CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.EDMUNDS 12576 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88764
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9224
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) OMAR MOHAMED A
(LAST FIRST,
ADDRESS&PHONE# D O.B.
11431 SE 162ND ST RENTON WA 98055 SEX M MMDOYyry 02 - 22 - 2000
PASSENGER Z WITNESS❑!UNIT# 1 PEA 3 AIRBAG'6 RESTR. 4 EJECT ? 1 HEL MET 2 INJURY
CLAS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) SANTOS RENTAO
ADDRESS&PHONE# D O B
SEATAC SEX' M MMoovvYv 04 f 7 _ 1943
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESSO UNIT# 2 PGS 3 AIRBAG'6 RESTR. 4 EJECT 1 USE 2 CLASS TRANSPORTEDDUE TO ELDERY
NAME
(LAST FIRST,MIDDLE INITIAL) BANDA ALFREDO R
AooREss PHONE# 2712 SE 16TH ST RENTON WA 98058 4256522223 SEX M D.C•B. 10 I. _ 05 _ 1971
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
E.EDMUNDS 08-12-23 02:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 8/13/2023 12:44:54 PM
BADGE OR ID# 12576 ORI#' WA0171300 TIME POLICE DISPATCHED 5:24 PM TIME POLICE ARRIVED',5:24 PM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED88764 CASE# 23-9224 OF COLLISION08/11/23 17:23
NARRATIVE
On 08/02/2023 1 was working a marked patrol unit in the City of Renton, County of King, State of
Washington. I was assigned to District 15. At approximately 1724 hours, I was dispatched to an
unknown injury collision in the 800 block of Benson RD S (Renton WA, King County).
Call notes stated:
"NOW... 2 VEH MVA... UNK INJS...BLOCKING... GRY HISS VS. GRY MAID... POSSIBLE MALE OR
FEMALE LAYING ON GROUND NEARBY.. ONE VEH SPUN AROUND... RP NO LONGER IN
AREA.. 2 MVA, SIL TOYT CAMRY VS SIL TOYT COROLLA, BLKIND ON BENSON, PT ON
GROUND, CONS, CO PAIN IN LEGS, CRYING HYSTERICALLY..."
I responded to the location and observed two vehicles- Vehicle #2 (WA/343YNO) and Vehicle #1
(WA/BWB7634) blocking both lanes of travel. Both vehicles had significant front-end damage. Vehicle
#1 had come to rest in the oncoming lane of traffic. Vehicle #2 was stopped in the center of its lane.
The damage to both vehicles appeared to exceed $1000.
The driver of Vehicle #1 (later identified as Ikram M Nur-11/15/2001) was laying down in the street,
complaining of pain in her legs and back. Her passenger (Mohammed A Omar-02/22/2000) was
standing with her, attempting to provide comfort. I advised incoming medical personnel of Nur's
location as they arrived.
I contacted the driver of Vehicle #2, Maryann N Felicidad -07/26/1968 at her vehicle. Felicidad was
standing on the passenger side of her vehicle, requesting aid for her passenger, Renato Santos -
04/17/1943. Santos did not have any visible injury but was slow to respond and appeared dazed. I
advised incoming medical personnel of Santos location as they arrived.
A witness to the collision, Alfredo R Banda -10/05/1971, flagged me down. Banda stated he was
driving south bound on Benson RD S near the police station when Vehicle #1 attempted to pass him
at a high rate of speed by changing lanes into oncoming traffic. Banda stated Vehicle #1 could not
complete the pass due to oncoming traffic and returned to the southbound lane, behind him. A short
distance later, Vehicle #1 attempted to pass Banda again by moving into oncoming traffic. This,
second, time Vehicle #1 struck Vehicle #2 head on.
I spoke with Felicidad, who described the accident in a similar manner. Felicidad stated she was
driving straight in her lane, when Vehicle #1 moved suddenly into her lane. Felicidad stated she did
not have time to swerve and avoid the collision.
Nur was unable to provide an account of the collision due to treatment of her injuries. Her passenger,
Omar, stated they were arguing in the vehicle, and he may have struck the gearshift inadvertently.
This caused Nur to lose control of the vehicle, moving into oncoming traffic.
An NCIC/WACIC check was conducted with both driver's information. Both returned clear. Felicidad
provided vehicle registration and proof of insurance. Omar was able to locate Nur's vehicle
registration, but not proof of insurance.
Nur and Santos were both transported to Valley Medical Center for evaluation and treatment. Gene
Meyer's towed both vehicles from the scene to their impound yard. I provided an exchange of
information to both parties.
This concluded my involvement with the case.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by E. Edmunds/12576 at 0241 hours on 08/12/2023 in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. ED88764 CASE# ' 23-9224 DATE AND TIME 08/11/23 17:23
OF COLLISION
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