HomeMy WebLinkAbout23-11057 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE02919 170
27
COLLISION REP FIT 1591971
CASE 23-11057 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&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# ❑
COLLISION.. 09 - 1-— 2023 1616 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 275 00 FMILES EET e S ❑ W e EAST VALLEYHWY
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066601474 0 11
30
6� LAST NAME RAMOS FIRSTNAME MICKEY MIDDLE N 1 2 31
INITIAL
STREET ❑, 4633 35TH ST NE CITY TACOMA ST WA 2jp, 984222506 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ p7 ATNES14 BYS9713 STATE WA VIN# JHMCG56601 CO19695
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. YRLR. 3 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO 7 3 34
13 2 2001 HOND ACCOR YES❑ NO✓
REGISTERED OWNER INFO JUAN RAMOS 442111STSTNE TACOMA WA 98422 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3
LIABILITY INSURANCE
IN EFFECT &POLICY# � 9TOP 5
vewcLE CHARGE 10 BOTTOM 36
LEGALLv YES No CITATION# 3A0681692,3A0681692 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING 8 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UN�T a2 ❑ PEDESTRIAN ❑ YES No D:2064 746810
VEHICLE CYCLE OWNER
16 a
LAST NAME HASSAN FIRST NAME HUSSEIN MIDDLE M
INITIAL
17❑ STREET ❑', 3035 S HOLLYPL CITY' SEATTLE ST WA ZIP 98108 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES t l NO❑
19 DRIVERS
# STATE WA SEX M Mr D.C.B. 04 13 _ 2004 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHP9094 TATe WA VIN# WA1LGAFE3ED005527
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2014 MAKE AUDl MODEL Q7 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HUSSEIN HASSAN 3035 S HOLLY PL SEATTLEWA98108 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE02919
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11057
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.
M.LEVERTON 09-27-23 09:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 912712023 10:18:58 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 4:20 Pry TIME POLICE ARRIVED',4:31 PM
PART I PAGE IT]OF 4�
REPORT NO. EE02919 CASE# 23-11057 OF COLLISION
09/26/23 16:16
OF CbLLI510N
NARRATIVE
gold sedan/1 It from 2wcltl gray suv/2 turn pocket
CC
Within the city limits of Renton/King/Wa I responded to a 2 car crash near the 300 block of SW 43rd
St.
I contacted the driver of unit 2 who told me he was east on SW 43rd St and in the turn pocket when
unit 1 turned left across his lane with no room to avoid contact. He did not complain of injury and
damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. Unit 1 said she thought unit 2 was going very
fast so she turned left across his lane very fast also. She told me she believed she had enough room
to make they turn but insisted unit 2 was going too fast and she could make her turn. She did not
understand she cant make the left until it is clear. She told me it was because another car waved her
to make her turn. She could not provide valid proof of insurance when requested. She did not
complain of injury and although damages required a tow truck she was able to move her car off the
road and made her own arraignments to have her vehicle recovered.
I cited Unit 1 Ramos, ref RCW 46.61.185 FTYROW-Left turn 2 car crash and ref RCW 46.30.020 No
Insurance via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 9/27/2023
PAGE 3 OF 4
REPORT NO. EE02919 CASE# ' 23-11057 DATE AND TIME 09/26/23 16:16
OF COLLISION
nts
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