HomeMy WebLinkAbout23-8636 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-8636 2 571
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 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# ❑
COLLISION: 07 - 1-- 2023 1657 17 ❑.❑ S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----�
SW 7TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e POWELL AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067952795 0 11
30
6❑ LAST NAME HUBBARD FIRSTNAME MICHELLE MIDDLE M 1 2 31
INITIAL
STREET ❑, 7641 S LAKERIDGE DR CITY SEATTLE ST WA ZIP, 98178 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 05 1- 29 - 1970 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATFBit BEN1993 sTArI WA VIN#' 3N1AB7AP5FY289087
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR $ 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 3 ] 34
13 8 2015 NISS SENTRA SD DAMAGE vEs 0NO agW�MEYERS ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO GENERAL INS WA9778904 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:9729986655
16 2
LAST NAME BAHRAMPOUR FIRST NAME BRAUM MIDDLE IS
INITIAL
17 STREET NEW ADOREs7 701 SW 5TH CT APT B404 CITY RENTON ST WA ZIP 98057 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK vEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. O6 _ 05 _ 1955 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES 40
USE CLASS NEC
❑
21❑ LICENSE I PLA E# CDV0062 TArE WA VIN# USE
K PAIN 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2002 MAKE CHEV MODEL TAHOE STYLE (/T —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO AAA TPA 146460072IN IUR
5
VE""LE ❑ ,J� CITATION# CHARGE LEGALYYES N`LJ
25 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. ED84873
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8636
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.
E.EDMUNDS 07-28-23 08:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:24:13 PM
BADGE OR ID# 12576 ORI#' WA0171300 TIME POLICE DISPATCHED! 4:88 PM TIME POLICE ARRIVED]5:00 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED84873 CASE# 23-8636 OF COLLISION
07/28/23 16:57
OF CbLLI510N
NARRATIVE
On 07/28/2023 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 1658 hours, I was dispatched to an
unknown injury, blocking collision near the intersection of Powell Ave SW and SW 7th ST (Renton
WA, King County).
I responded to the location and observed two vehicles- Vehicle #2 (WA/CDV0062) stopped in the
westbound lane on SW 7th ST and Vehicle #1 (WA/BEN1993) stopped in the southbound lane on
Powell AVE SW.
Vehicle #1 had damage to the front bumper. The damage appeared to exceed $1000. Vehicle #2 had
damage to the driver side front end. The damage appeared exceed $1000.
The driver of vehicle #1, Michelle M Hubbard (05/29/1970) stated he was turning left from Powell Ave
SW onto SW 7th ST. Hubbard claimed she checked traffic east and west, thought she was clear to
enter, and began the turn. Hubbard stated she misjudged the speed of Vehicle #2 and collided with it,
spinning her vehicle around and coming to rest in the southbound lane of Powell Ave SW.
The driver of vehicle #2 Braum S Bahrampour (06/05/1955) described the collision in the same
manner. Bahrampour stated he was traveling westbound in his lane when vehicle #1 entered the
roadway from Powell Ave S. Bahrampour stated the vehicle was moving too quickly for him to avoid
the collision.
Both drivers provided a WA DL, current registration certificate, and proof of insurance. An
NCIC/WACIC check was conducted with both driver's information. Both returned clear. Medics
checked both drivers. Bahrampour required further attention and was transported to Valley Medical
Center.
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 1939 hours on 07/28/2023 in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. ED84873 CASE# ' 23-8636 DATE AND TIME 07/28/23 16:57
OF COLLISION
SW 7th S
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