HomeMy WebLinkAbout23-5386 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5386 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# ❑
cowsloN 05 - 1-- 2023 1652 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW SUNSET BLVD BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e HARDIEAVESW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4252423258 0 11
30
6� LAST NAME RIVITUSO FIRSTNAME ANTHONY MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 4721 SUNSET DR W CITY UNIVERSITY PLACE ST WA 21p, 98466 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs ,/ I NO NTERLOCKYEs NO Z YEs No�/
$❑ LRIIVER # STATE WA SEX'M MMDD 03 - 08 - 1962 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 99 PI ATE 14 CFE7211 sTAT WA u N#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 3 33
12 2 5 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 4 2023 TOYT CAMRY SD DAMAGE YES NO YES NO✓
[WIREGISTERED OWNER INFO OB RENTON INC 150 SW 7TH ST RENTON WA 98055 D:4252423258 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITYINSURANCE INSURANCE CO FEDERATED INSURANCE 0971734 4
IN EFFECT &POLICY# C;��
❑ ve'C CHARGE 36
152 L-ALLLN YEs No clTAnoN# 3A0210038 FAIL YIELD PRIVATE RD MOTOR
MOTOR PEDAL- ❑ :PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES NO ,/ D:2064555317
16 a
LAST NAME ABDI FIRST NAME MUSA MIDDLE A
INITIAL
17 STREET❑ NEW ADDREss❑' 600 SW 5TH CT#K402 CITY RENTON ST WA ZIP 98055 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CBJ5507 TATE WA VIN# 41
SFNYF8H09M6035096 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE HOND MODEL PILOT EX STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO FARHIA ARAB 600 SW5TH CT#K402 RENTON WA 98055 D:2064555317 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 POLICY#E CO SAFECO H2530667IN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
R.PHILLIPS 11649 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED59812
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5386
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ARAB FARHIA A
(LAST FIRST,
ADDRESS&PHONE#
600 SW 5TH CT#K402 RENTON WA 98055 2064555317 SEXi F MMDovyry 11 - 30 - 1993
PASSENGER WITNESS UNIT# 2 SPAT
7 AIRBAG 2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
OS. USE 1 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) ADAN TASNEEM M
ADDRESS&PHONE# D O B
600 SW 5TH CT#K402 RENTON WA 98055 SEX
' U MMoovvvv 02 _ 22 _ 2023
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER P]WITNESS UNIT# 2 PGS 9 AIRBAG 2 RESTR. 11 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
R.PHILLIPS 05-13-23 09:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 511312023 1:22:28 PM
BADGE OR ID# 11649 OR]# WA0171300 TIME POLICE DISPATCHED 4:54 PM TIME POLICE ARRIVED',5:04 PM
PART I PAGE IT]OF 4�
REPORT NO. ED59812 CASE# 23-5386 OF COLLISION
05/12/23 16:52
OF CbLLI510N
NARRATIVE
On 05-12-2023 at 1654 hours I was dispatched to a crash at SW Sunset BLVD and Hardie Ave SW in
the City of Renton, King County WA. I arrived on scene and observed a maroon Honda Pilot blocking
traffic westbound in the number two lane. There was a red Camry blocking east bound in the number
one lane.
I contacted all the parties. The occupants of the Pilot wanted Fire to respond due to an infant in the
car. The driver of the Camry was not injured. Renton Fire arrived and checked vitals. The driver of the
Pilot, Musa Abdi told me he was driving westbound on SW Sunset BLVD when the red Camry pulled
out of the gas station parking lot in front of him causing the collision. The Camry was attempting to
cross all lanes of traffic to go east on SW Sunset BLVD.
Abdi, his wife Farhia Arab and their child were going to go to Valley Medical Center as a precaution
after they cleared the scene.
I spoke with the driver of the Camry, Anthony Rivituso who stated he pulled out of the gas station
parking lot and didn't see the Pilot driving west bound.
Rivituso was cited for failing to yield.
Both parties were given the case number.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct. This report was electronically signed by Officer R. Phillips #11649, May
12th, 2023, Renton, WA.
PAGE 3 OF 4
REPORT NO. ED59812 CASE# ' 23-5386 DATE AND TIME 05/12/23 16:52
OF COLLISION
Hardie Ave SW
Gas station parking:at.
Not to Scale
SW'unset BLVD
PAGE 4 OF 4