HomeMy WebLinkAbout23-9949 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED97758 170
27
COLLISION REP FIT 1591971
CASE 23-9949 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 08 - 1-- 2023 1308 17 ❑.= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND STREET BLOCK NO. e✓ 100
4a 1❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 277 00 FMILES EET e S ❑ E e LAKEAVES
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4258906545 0 11
30
6� LAST NAME HALL FIRSTNAME DAVID MIDDLE L 1 2 31
INITIAL
STREET ❑ 20502 216TH AVE SE CITY RENTON ST WA ZIP 980580279 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ PICENS11 ATE 14 AZM5170 STATE WA u N# JF2SHABC1BH747370
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 5 33
12 2 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 1 2011 SUBA FOREST 4W DAMAGE vesNo ves❑ No
REGISTEREDOWNERINFO DAV/DHALL20502216TH AVE SE RENTON WA98058 D:4258906545 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NPOLICY E CO STATE FARM 121 7838-C23.47B 4
LI EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:7025381560
16 a
LAST NAME NIKKHAH MANESH FIRST NAME SABA MIDDLE
INITIAL
17 STREET❑ NEW ADDREss❑' 225 LOGAN AVE S APT 147 CITY RENTON ST WA ZIP 980572057 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED � 38
INTERLOCKYEs❑No INTERLOCK ves I I No� YEs F NDF,/]
19 DRIVER'S STATE WA SEX F D.O.B. 09 _ 15 _ 1990 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR g EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# 41
CDV7802 TATE WA VIN1 2HGFG12837H510414 1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2007 MAKE HOND MODEL CIVIC STYLE CP VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SABA NIKKHAH MANESH 225 LOGAN AVE S APT 147 RENTONWA98057 D:7025381560 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 960-781-554IN IGQI
vE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97758
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9949
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
PM 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.
MATTHEW NUGENT 08-29-23 04:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 911112023 7:53:38 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 1:13 PM TIME POLICE ARRIVED 1:13 PM
PART I PAGE IT]OF 4�
REPORT NO. ED97758 CASE# 23-9949 OF COLLISION
08/29/23 13:08
OF CbLLI510N
NARRATIVE
23-9949
On 08/29/2023 at approximately 1313 hours, I was dispatched to an non-injury vehicle collision at the
intersection of South 2nd Street and Lake AVE South, within the City Limits of Renton, County of
King, State of Washington.
Upon my arrival, I noticed both vehicles were in the NE corner of Safeway parking lot. Once I made
contact, both drivers stated there was no injury's and did not need Renton Fire Authority. While on
scene, I was able to collect each involved party's information and summary.
The driver of Unit#1 said he was traveling westbound in about the 200 block of South 2nd Street
(one-way road) in lane 2 of 4. He stated once he passed the median divider, he thought he was in
oncoming traffic and quickly changed lanes. He moved from lane 2 to lane 3 and then lane 4 where
he collided with Unit#2.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling westbound
in about the 200 block of South 2nd Street (one-way road) approaching the intersection of Lake Ave
South but in lane 4 of 4. The driver of Unit#2 stated she was intending to continue west when Unit#1
changed lanes from lane 2 of 4 and into lane 3 of 4 then 4 of 4 which Unit#2 was occupying. Unit#2
was unable to avoid the collision and subsequently received moderate damage to the front passenger
side of Unit#2.
Based on the above statements, I determined that the Driver of Unit#1 (Hall) was the predominant
factor for the collision as Hall made an improper turn and was not clear of traffic causing a collision.
Both vehicles were able to be driven away without further incident. I provided both parties with a case
number and exchange of information.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 4:14 PM 8/29/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED97758 CASE# ' 23-9949 DATE AND TIME 08/29/23 13:08
OF COLLISION
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