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Home My WebLink About23-13760 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-13760 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# cawsloN 11 - 1-- 2023 1118 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ EAST VALLEYROAD BLOCK NO. e✓ 4100 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ VV e SW 41ST STREET 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO D:2063228461 0 11 30 6� LAST NAME MAMON FIRSTNAME MARK MIDDLE G 1 1 2 31 INITIAL STREET ❑ 19829 133RD PL SE CITY RENTON ST WA 7jp, 980587791 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 2 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10 1❑ P1 ATE 14 C770762 STATE WA u N# 1 HTMKAAN17H409263 11[-j- TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# IR.. ro TRLR. A'RLR. 1 3 33 12 3 5 VIN#j VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13 2 2007 INTL 4000 CG DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO PACIFIC NORTHWEST SHREDDING INC 3215 LAFAYETTEAVE S SEATTLE WA 981" D:2063228461 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE z INSURANCE CO PROGRESSIVE 03557973.8 4 LI EFFECT I POLICY# TOPVEHICLE CHARGE 36 LEGALLv res❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067718058 16 a LAST NAME FAIZI FIRST NAME AHMAD MIDDLE I L INITIAL 17 STREET❑ NEW ADDRESS❑' 10433 SE KENT KANGLEY RD APT CITY KENT ST WA ZIP 980307601 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DRIVEW # ❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES ❑ 40 USE CLASS LEFT HAND LACERATION LICENSE I ❑21❑ PLA E# CFX8694 TATE 41 WA VIN t 5YFBURHEXGP522278 1 42 22❑ PLATE# STATE pLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2016 MAKE TOy7- MODEL COROLL STYLE qD I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO AHMAD FAIZI 10433 SE KENT KANGLEY RD APT KENT WA 98030 D:2067718058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE I PORGY#ECO AMERICAN FAMILY 41083-10034-57 9TOP 5 IN EFFECT 'E""Le ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N`L J 25 ' a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77AGENCY 26 MATTHEW NUGENT 11498 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE26988 COLLISION REPORT III III III III III 111 1591972 CASE# 23-13760 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. MATTHEW NUGENT 11-30-23 06:38 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 12/5/2023 11:31:20 AM BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 11:18 AM TIME POLICE ARRIVED',11:20 AM PART I PAGE IT]OF 5� REPORT NO. EE26988 CASE# 23-13760 OF COLLISION 11/30/23 11:18 OF CbLLI510N NARRATIVE 23-13760 On 11/30/2023 at approximately 1118 hours, I was dispatched to an unknown-if-injury and blocking vehicle collision at the intersection of SW 41st Street and East Valley Road, within the City Limits of Renton, County of King, State of Washington. Upon arrival, Officer N. Brown had already arrived on scene and confirmed there were no complaints of injury requiring immediate medical response at the time of report. While on scene, I collected each involved party's driving documents and independent involvement leading up to the collision. The driver of Unit#1 stated he was the sole occupant of his company's commercial vehicle and had been traveling southbound along East Valley Road. The driver of Unit#1 stated that she was intending to make a left turn at the controlled intersection of SW 41 st Street to proceed onto SR-167 following the turn. The driver of Unit#1 stated that the traffic light was a solid yellow light and that as he entered the intersection, the light turned from yellow to red but that he was already past the stop bar and into his turn. As Unit#1 began to turn in the intersection, Unit#1 was met by another vehicle - Unit#2. The driver of Unit#1 stated that he was unable to avoid the collision after having pulled out into the intersection and that both vehicles collided causing moderate damage to the front bumper of Unit#1. The driver of Unit#2 said he was the sole occupant of his vehicle and was traveling northbound in about the 4100 block of East Valley Road in lane 2 of 3. The driver of Unit#2 stated he was intending to continue north upon reaching the controlled intersection of SW 41st ST. Upon reaching the intersection, which the driver of Unit#2 alleges was a solid green light, the driver of Unit#2 observed Unit#1 turn across his lane of travel. The driver of Unit#2 stated that he was unable to avoid the collision. Both vehicles collided in the roadway and Unit#2 suffered moderate damage to the front driver's side of the vehicle. There were no witnesses or traffic camera coverage of the above-mentioned incident therefore this report is informational only at this time. Unit#1 was moved off the roadway. 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 6:36 PM 11/30/2023 Renton, King County, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE26988 r`I POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-13760 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G UNIT# 1 USDOT 2178227 ICC# VEHICLE TYPE 2 CARGO BODY 2 TYPE 2 ❑ 1 28 CARRIER NAME PACIFIC NW SHREDDING INC. ....... 3 CARRIER ADDRESS 3215 LAFAYETTE AVE S CITY SEATTLE ST WA ZIP'', 98144 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 3 AXLES 03 GI NAME + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFSP CITY ST ZIP 6 � CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No INTERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NFln+AnntxFs.� CITY'. ST 21P CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs N. El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MATTHEW NUGENT 11-30-23 06:38 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OI BADGE 11498 O#I',WA0171300 JACOBS 12/5/2023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE26988 CASE# ' 23-13760 DATE AND TIME 11/30/23 11:18 OF COLLISION 017 PAGE 5 OF 5