HomeMy WebLinkAbout23-11818 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11818 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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#
cowsloN 10 - 1-- 2023 1722 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW SUNSET BLVD BLOCK NO. e✓ 700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV e SW 4TH PL
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069489908 0 11
30
6� LAST NAME HENRY FIRSTNAME SHELLEEN MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 5955 S LANGSTON RD CITy SEATTLE ST WA ZIP, 981780000 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I iNTERLOCKYEs No NTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG I [NATURE OF
2 RESTR 4 EJECT 1 H U EET 2 CLASS ju C/O LOWER BAICK ES PAIN z❑
3
10 9❑ P1 ATE 14 BDR6119 JBTATIJ WAv N If JM3TCBCY7G0119098
TRAILER STATE TRAILER STATE
11 3 5 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Vqy /(g GOVT.VEHICLE 3 ] 34
13 2 ZO16 MAID CX 9 SV DAMAGE YES NO - RS YES[:] NO✓
REGISTERED OWNER INFO A13..R ABDUL RA.N 8316 S 126TH ST SEATTLE WA 98178 D:2069489908 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO NATIONWIDE 7246JO62564
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# BOTTOM
15❑ STAIN.D'ING 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME HERMAN FIRST NAME JAMES MIDDLE I L
INITIAL
17 STREET❑ NEW ADOREss❑' 4612 13TH AVE S CITY SEATTLE ST WA ZIP 981081842 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDICENS STATE WA SEX M M D.C.B. 07 25 _ 1951 39
20❑ ON DUTY STATUS AIRBAG g RESTR 4 EJECT 1 H EET 2 NJAU Sy 6 C/O LEFT SHOULDER PAIN ❑[-�A—TUREOF INJURIES 40
❑21❑ 41
ILICENSE PLA E# ANF6703 TArE WA VIN# 2D4FV47V97H622304 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2007 MAKE DODG MODEL MAGNUM STYLE 4W --VEHICLE
TOWED✓ NOO BLIN BANKERS YES No✓
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
'E""Le ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`L J
25 ' a
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE12042
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11818
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ABDUL RAHMAN CAIRO H
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
813 S.126TH ST SEATTLE WA 98178 2069489908 SEX M MMDOYyry 09 - 16 - 2019
PASSENGER WITNESS UNIT# SEAT ' AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑' 1 POS. 7 2 12 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) ABDUL RAHMAN NEEMA M
ADDRESS&PHONE# D O B
813 S.126TH ST SEATTLE WA 98178 SEX F MMDDYYvv 12 _ 05 _ 2013
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER RVWITNESS❑ UNIT# 1 POS 8 AIRBAG 2 RESTR. 12 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) ABDUL RAHMAN ZURI I
AooREss&PHONE# 813 S.126TH ST SEATTLE WA 98178 SEXF 08 30 _ 2018
. D.O.B. _
MMDDYYYY
PASSENGER WITNESS UNIT# ! 1 SEAT g AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 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 10-19-23 03:23 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1012312023 11:23:04 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 5:24 PM TIME POLICE ARRIVED',5:34 PM
PART I PAGE IT]OF 4�
REPORT NO. EE12042 CASE# 23-11818 OF COLLISION
10/16/23 17:22
OF CbLLI510N
NARRATIVE
23-11818
On 10/16/2023 at approximately 1724 hours, I was dispatched to a blocking vehicle collision at the
intersection of SW Sunset Boulevard and SW 4th Place, within the City Limits of Renton, County of
King, State of Washington.
While en route, dispatch advised of two involved vehicles blocking the westbound lanes of travel.
Upon my arrival, I confirmed the involved parties were complaining of injury therefore I requested the
Renton Regional Fire Authority (RRFA) respond to the scene. RRFA later responded and evaluated
all involved parties at the scene. The involved drivers were treated and released at the scene by
RRFA. While on scene, I collected each of the involved party's information and their independent
involvement leading up to the collision.
The driver of Unit#1 stated that she and three juvenile passengers were traveling eastbound in about
the 700 block of SW Sunset Blvd and approaching the intersection of SW 4th PI in lane 2 of 2. The
driver of Unit#1 stated that traffic had queued ahead of her vehicle for an uninvolved and turning
vehicle, and that she needed to come to an abrupt stop. The driver of Unit#1 tried to avoid colliding
with stopped traffic ahead of her by swerving into the oncoming lane of travel, specifically lane 2 of 2
for westbound SW Sunset Blvd. Upon Unit#1 swerving into the oncoming lane of travel, Unit#1
made contact with Unit#2. Both vehicles collided in the roadway in what is referred to as an offset
head-on collision. Unit#1 suffered significant damage to the front driver's side of the vehicle,
including a severed front wheel bearing because of the collision.
The driver of Unit#2 stated that he was the sole occupant of his vehicle and was traveling westbound
in the 700 block of SW Sunset Blvd (JWO SW 4th PL) in lane 2 of 2. The driver of Unit#2 stated that
he was intending to continue west when Unit#1 turned into his lane of travel. The driver of Unit#2
stated that he was unable to avoid the collision. Unit#2 suffered significant damage to the front and
side of the vehicle because of the collsiion.
I believe the driver of Unit#1 (HENRY) is the predominant factor for the cause of collision as Henry
violated RCW 46.61.140(1) which states that a vehicle shall be driven as nearly as practicable
entirely within a single lane and shall not be moved from such lane until the driver has first
ascertained that such movement can be made with safety. Henry made a lane change into Unit#2's
lane of travel which had the right of way and was underway.
Both Unit#1 and Unit#2 had to be impounded due to extensive damage. An exchange of
information was provided to all involved parties.
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 2:46 PM 10/19/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO.! EE12042 CASE# ' 23-11818 DATE AND TIME 10/16/23 17:22
OF COLLISION
r.11.3
Unit#1 not to scale
Unit1
PAGE 4 OF 4