HomeMy WebLinkAbout23-12601 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12601 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.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 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 11 - 1-- 2023 0925 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 128TH ST BLOCK NO. e✓ 15500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FMILES N EET e S ❑ E e 156THAVESE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2533911686 0 81
30
6� LAST NAME ESMAEILI FIRSTNAME FARAZ MIDDLE 1 2 31
INITIAL
STREET ❑ 14117 SE 177TH ST APT H101 CITY RENTON ST WA 7jp, 980589221 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 08 1— 19 — 1987 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CKE1675 sTAr� WAVIN# 5N1ED28T64C686985
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. To
TRLR. TRLR 5 7 33
12 0 0 VIN#j VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 9 34
13 2 2004 NISS XTERRA DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2020481365 3 4
IN EFFECT &POLICY# 9TOP
vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2068195973
16 a
LAST NAME WITTER FIRST NAME BREEANA MIDDLE I L
INITIAL
17❑ STREET ❑', 185 SW CLARK ST APT D1 CITY' ISSAQUAH ST WA ZIP 980273709 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO/
19 D IVERI #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BU65340 TAre WA vIN# JM3KE4DY8G0859789
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
Gov HI
VEH YEAR 2016 MAKE IlggZp MODEL CX-5 STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY 44
ES 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 STATE FARM 169 2416-D10-47DIN I STOP 5
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ a
7.FF1CJEO-S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE18228
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12601
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 URE OF INJURIES
NAT
❑ ❑ 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.
CO.JOHNSON 11-03-23 08:37AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 111912023 4:20:33 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 9:37 AM TIME POLICE ARRIVED]9:47 AM
PART I PAGE IT]OF 4]
REPORT NO. EE18228 CASE# 23-12601 OF COLLISION
11/02/23 09:25
OF CbLLI510N
NARRATIVE
U2 EB 15500 blk SE 128th St, lane #2 stopped for red signal, 2nd car from line; U1 NB 156th Ave SE
left turn to WB SE 128th St on green, U1 slipped in turn and impacted U2; roadway wet, raining
On 11-02-2023 at about 0937 hours, I was dispatched to a collision in the vicinity of SE 128th St and
156th Ave SE in the City of Renton, County of King, Washington State. Both vehicles were pulled to
the west side of 156th Ave SE and there were no reported injuries. I arrived in the area at 0947
hours.
I contacted the driver of Unit 02 who was was identified by WA DL. The driver said she was not
injured and was wearing a seatbelt at the time of the collision. Unit 02 was east bound in lane #2 of
SE 128th St and stopped for a red traffic signal with an uninvolved vehicle to the front of their vehicle.
The driver observed Unit 01 turn left from 156th Ave SE, fish tail while in the turn and then collide with
Unit 02.
1 contacted the driver of Unit 01 who was was identified by WA DL. The driver said he was not injured
and was wearing a seatbelt at the time of the collision. Unit 01 was north bound on 156th Ave SE
and turned left onto west bound SE 128th St. Unit 01 lost traction with the roadway surface while in
the turn and the rear of the vehicle rotated in a counter clockwise direction. The passenger side
fender of Unit 01 collided with the driver side front corner of Unit 02.
While speaking with the drivers it was raining and the roadway surface was wet. There had been rain
and intermittent rain shower throughout the morning in the area. The damage to both vehicles was
consistent with the information provided by the drivers.
The proximate cause of the collision was Unit 01 travelling at a speed to great for the weather or
roadway conditions (RCW 46.61.400.3). Were it not for the actions of the driver of Unit 01, the
collision would not have occurred.
No citations or infractions issued. Report for information and insurance purpose only.
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REPORT NO.! EE18228 CASE# ' 23-12601 DATE AND TIME 11/02/23 09:25
OF COLLISION
SE 1
W� I
i
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