HomeMy WebLinkAbout23-11815 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11815 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 10 - 1-- 2023 1607 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LAKE YOUNGS WAY SE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SE 16TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2066063603 0 11
30
6� LAST NAME FARAH FIRSTNAME MOHAMED MIDDLE G 1 2 31
INITIAL
STREET ❑ 21800 PACIFIC HWY S APT B506 CITY DES MOINES ST WA 21p 98198 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CFD5067 sTArI WAvIN# JTDZN3EU1D3273121
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2013 TOYT PRIUS GA DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO ACORD ASE-665-067247.533 4
LI EFFECT I POLICY# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 3A0722964 FAIL TO YIELD MOTOR VEHICLE <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- '.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D.2064277135
16 a
LAST NAME BLOEDEL FIRST NAME NATHAN MIDDLE IR
INITIAL
17 STREET❑ NEW ADOREsS❑' 3113 SE 18TH ST CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[—] LICENSE# STATE WA SEX M M D.C.B. 11 07 1985 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CHY0684 TArE 41
WA VIN# KM8KNDAFSPU203835 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
Gov HI
VEH D
YEAR 2023 MAKE yy�N MODEL IONIC 5 STYLE UT AMAGE TOWED NOO✓ BLIN TOWED BY 44
fj
YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 817 270 963IN I STOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 $
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10273
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11815
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BLOEDEL SAMANTHA
(LAST FIRST,
ADDRESS&PHONE# D O.B.
RENTON WA SEX' F MMDDYYYY 10 - 21 - 2008
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. 11 2 4 1 USE 2 CLASS ,1
NAME
(LAST,FIRST,MIDDLE INITIAL) BLOEDEL PETER
ADDRESS&PHONE# Ly O B
RENTON WA SEX: M MMDDvvvv 03 _ 19 _ 2011
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
BENJAMIN FLICK 10-16-23 05:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 1011712023 6:25:58 PM
BADGE OR ID# 12825 OR]# WA0171300 TIME POLICE DISPATCHED! 4:98 Pry/ TIME POLICE ARRIVED',4:25 PM
PART I PAGE IT]OF 4�
REPORT NO. EE10273 CASE# 23-11815 OF COLLISION
10/16/23 16:07
OF CbLLI510N
NARRATIVE
23-11815
On 10-16-2023 at approximately 1618 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at the
cross of SE 16th St and Lake Youngs Way SE.
Upon arrival I made contact with all both vehicles involved. Both involved drivers agreed upon the
circumstances that occurred. The involved units and drivers were identified as follows:
Unit 1 (WA/CFD5067) driver Mohamed G. Farah (DOB: 10-05-1969 via WADOL)
Unit 2 (WA/CHY0684) driver Nathan R. Bloedel (DOB: 11-07-1985 via WADOL)
Unit 01 stopped at the stop sign, but then proceeded through the intersection eastbound on SE 16th
ST. Unit 01 did not see unit 02 approaching on Lake Youngs Way SE and collided with unit 02. Unit
02 did not have a stop sign. Unit 01 had the stop sign.
I provided both parties with a business card which contained the case number.
I observed that the damage to the vehicles was consistent with what both parties had told me.
At the conclusion of my investigation, I determined that driver Farah had failed to yield right of way to
unit 02 after Farah stopped at the stop sign. 1 confirmed with driver Farah that his DOL address was
current. I informed him that he would be receiving a citation for failure to yield right of way via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 10-16-2023 in Renton, WA.
PAGE 3 OF 4
REPORTNO. EE10 7 RASE# 2y]]a]5 DATE m°M} ]±16/23 ]E07
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