HomeMy WebLinkAbout23-9586 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-9586 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 1523 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e✓ 1820
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e UNNAMED
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2062514502 0 4 30
6 LAST NAME ROA PENA FIRSTNAME JOSE-ANTONIO MIDDLE 1 2 31
INITIAL
STREET ❑ 27459 149TH PL SE APT 72 APT 72 CITY KENT ST WA 2jp, 980424365 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YES No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 1❑ P1 aT�S� BCV7450 sTAT� WA VIN# 1NXBU40EX9Z131888
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 4 6 33
12 4 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/g[ GOVT.VEHICLE 34
13 4 2009 TOYT COROL SD DAMAG 7 1 E YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 47.2BCC-K18 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252562474
16 2
LAST NAME ABOU GAZALA FIRST NAME NEVEN MIDDLE
INITIAL
17 STREET NEW ADDREsS❑' 8620 137TH AVE SE CITY NEWCASTLE ST WA ZIP 980593493 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INERLOCKYES❑NO� INTERLOCK YEs❑NOF YES❑NOF,/
19 D IVE #
❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CAP4759 TATE WA VIN# 41
SYJYGDEEOMF254972 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2021 MAKE TESL MODEL MODE!Y STYLE $D —VEHICLE
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 &POINSURGY#E CO STATE FARM 1793750-E11-47DIN I STOP
VEHICLE YES[:] N
C[:] CITATION# CHARGE i o BOTTOM
LEGALLY
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MATTHEW TRAINO 12811 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED93585
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9586
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ABOU GAZALA OMAR
(LAST FIRST,
ADDRESS&PHONE#
8620 137TH AVE SE NEWCASTLE WA 98059 SEX M MMDOYyry 03 - 13 - 2014
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 7 2 4 1 USE 2 CLASS 1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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.MMDD -❑
YYYY.
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.
MATTHEW TRAINO 08-23-23 05:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 812812023 10:39:39 AM
BADGE OR ID# 112811 ORI# WA0171300 TIME POLICE DISPATCHED 3:24 PM TIME POLICE ARRIVED',3:31 PM
PART I PAGE IT]OF 4�
REPORT NO. ED93585 CASE# 23-9586 OF COLLISION
08/20/23 15:23
OF CbLLI510N
NARRATIVE
At the referenced time and location, I was dispatched to a reported motor vehicle accident within the
City of Renton, County of King, State of Washington. Upon arrival I observed that Unit#1, a Toyota
Corolla (WA Plate BCV7450) had struck Unit#2, a Tesla (WA Plate CAP4759). Both vehicles were
stopped in the driveway of the Best Western Hotel at the referenced location. Airbags were deployed
on both vehicles and Renton Fire was requested precautionary.
I contacted the driver of U1, identified by his WADOL as Jose-Antonio Roa Pena (09/23/1964), and
asked him to describe what had occurred. He said he was heading northbound in the right-hand lane,
intending to turn onto the onramp of 405N. According to the driver, he was following another vehicle
when the driver of U2 turned in front of him. Pena was unable to say exactly how fast he was going,
and said that he thought he had a green light because he was following the car in front of him and it
went through the intersection before him. Pena reported no injuries.
I contacted the driver of U1, identified by her WADOL as Neven Abou Gazala (02/24/1974), and
asked her to describe what had occurred. Gazala stated that she was heading southbound in the left-
hand lane of Maple Valley Hwy, and had intended to turn left into the driveway of the Best Western
Hotel. Gazala said that she thought she had a green turn arrow, and that she had initiated her turn
when her vehicle was struck by U1. Neither Gazala nor her passenger son reported any injuries.
U1 and U2 sustained moderate damage and were towed at the owners request from the scene.
During this incident, portions of the 405 freeway were closed, which caused an increase of rerouted
traffic in the area. While on scene, I observed failure to obey and failure to yield traffic violations at
this intersection. Neither driver expressed confidence that they had a green signal light, and no
witnesses remained on scene. Based on the totality of the circumstances and the observed traffic on
scene, I did not cite either driver for a traffic infraction.
N/F.
PAGE 3 OF 4
REPORT NO. ED93585 CASE# ' 23-9586 DATE AND TIME 08/20/23 15:23
OF COLLISION
Not to.Scale
F.H.2
Scene Not Observed
Closed Sheri's Location
e10
e
Point oflrnpact ` d0
i}
Unit#`I
6 t
my
PAGE 4 OF 4