HomeMy WebLinkAbout23-14639 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14639 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 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#
cawsloN 12 - 21 - 2023 0835 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
UNION AVE NE BLOCK NO. e✓ 600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 6TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069410273 0 4 30
6❑ LAST NAME VELASCO RAMOS FIRST NAME NORMA MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 432 MONROE AVE NE APT 102 CITY RENTON ST WA ZIP' 980568411 z
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 01 1- 09 - 1990 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 2 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 2❑ p7 ATE 14 BUB2178 STATE WA uN# 1HGCP2F36CA030349
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 1 34
13 2012 HOND ACCOR SD DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO NORMA VELASCORAMOS 432 MONROEAVENEAPT 102 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO PROGRESSIVE 939866049 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:8607098285
16 a
LAST NAME AMIRI FIRST NAME ROBINA MIDDLE
INITIAL
17 STREET NEW ADDRESS❑' 5718 NE 3RD PL CITY RENTON ST WA ZIP 980594888 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 STATEWASEXF .CB. _ 39
LICENSE# M .
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ ILICENSE PLA E# BEB9632 TATE WA VIN# 2T1BU4EE7DC985319 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE TOYT MODEL COROLL STYLE SO VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO MEYERS YES NO
REGISTERED OWNER INFO POPAL SHAIRZA15718 NE 3RD PL RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO SAFECO H2475212IN 1 9TOP
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE34521
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14639
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SHA/RZAI YOUSRA
(LAST FIRST,
ADDRESS&PHONE# D O.B.
5718 NE 3RD PL RENTON WA 98059 SEXi F MMDDWyry 08 - 13 - 2018
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
❑✓ ❑ 2 POS, 9 6 10 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) ASMA SHAIRZAI
ADDRESS&PHONE# DOB
5718 NE 3RD PL RENTON WA 98059 SEX' F MM.D Wvvv 08 - 13 - 2018
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 PGS 7 AIRBAG 6 RESTR. 10 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YWYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
I was dispatched to the collision on 12/21/23 at 0837 hours at Union AVE NE and NE 6th ST in city
Renton, King county WA.
Unit 1 BUB2178 Driver VELASCO RAMOS, NORMA (01/09/1990)
Unit 2 BEB9632 Driver AMIRI, ROBINA (11/12/1994)
Both drivers were identified by their WADL.
Unit 1 was traveling South on Union AVE NE approaching the intersection of Union AVE NE and NE
6th St. Unit 1 then stated that Unit 2 pulled out in front of Unit 1 and Unit 1 crashed into Unit 2. Unit 2
was traveling East on NE 6th St when they came to the intersection of NE 6th St and Union AVE NE.
Unit 2 stated they stopped at the stop sign to clear the intersection. Unit 2 then turned left onto Union
AVE NE to travel North when they were struck by Unit 1.
Both drivers stated they had no injuries on scene, both declined medical treatment by fire.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 12-21-23 11:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 12/26/2023 6:08:45 PM
BADGE OR ID# 1Y808 OR]# WA0171300 TIME POLICE DISPATCHED 8:37 AM TIME POLICE ARRIVED',8:40 AM
PART I PAGE ❑OF❑
REPORT NO. EE34521 CASE# 23-14639 DATE AND TIME 12/21/23 08:35
OF COLLISION
scale not to size
'po*t of iimpact
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