HomeMy WebLinkAbout24-7450 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE97377 170
27
COLLISION REP FIT 1591971
CASE 24-7450 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 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# ❑
cowsloN 07 - 1-- 2024 1520 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 77
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 125 00 FEET MILES e S B W e SW HAYLES PL
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063535487 0 11
30
6� LAST NAME MOHAMED FIRSTNAME ASLI MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 9651 56TH AVE S CITY SEATTLE WA
NEW ADDRESS ST 21P 981185712 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CGJ1542 sTArI WAurN# 4T18E32K45tl018846
TRAILER STATE 7RAILEk STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2005 TOYT CAMRY DAMAGE vEs 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO KHADAR MOHAMED 2811 S ADAMS ST SEATTLE WA 98108 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
ve'CLE CHARGE 1 o BOTTOM 36
LEGALLY YES No CITATION 4A0361541,4A0361541, FAIL YIELD PRIVATE RD MOTOR
15❑ NDING 8 6
1.' MOTOR PEDAL-: PROPERTY DAM THR PHONE
UNIT 02 VE OLD MET HICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES�/ NO D:2067550684
16 2
LAST NAME CHRISTENSEN FIRST NAME ROBERT MIDDLE W
INITIAL
17❑ STREET ❑', 9812 339TH ST S CITY' ROY ST WA ZIP 985809480 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 F] STATEWASEXM El 39
LICENSE# M D.C.B. 2
HELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CH62726 TAre WA vIN# 4S3BWAD6XP3011592
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE SIJBA MODEL LEGACY STYLE I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO ROBERT CHRISTENSEN 9812339TH ST S ROY WA 985809480 D:2067550684 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO ST FARM 538 0377 D24 47IN 1 STOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE97377
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7450
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.
M.LEVERTON 07-17-24 06:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 711912024 2:59:39 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 3:21 PM TIME POLICE ARRIVED]3:21 PM
PART I PAGE IT]OF 4�
REPORT NO. EE97377 CASE# 24-7450 OF COLLISION
07/16/24 15:20
OF CbLLI510N
NARRATIVE
blk sedan/1 It from bb car wash unit 2 lane 2 nb
CC
4-27-24 no ins 61.205 nlov 2nd
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at 77 Rainier Ave S.
I contacted the driver of unit 2 who told me he was northbound lane 2 when unit 1 pulled from the
Brownbear carwash parking lot and drove into the side of his car. He did not complain of injury and
damages did require a tow truck.
I contacted the driver of unit 1 ID'd by her non picture WA drivers permit. She told me she was
making a left turn from the parking lot of Brownbear carwash and crashed into the side of unit 2. She
knew she only had a permit and the requirements but was driving without a licensed driver. The tabs
of her vehicle displayed 4-2024 and her registration showed an expiration of 4-27-2024. When
asked for her proof of insurance she said she did not have valid proof of insurance.
I cited Unit 1 driver ref RCW 46.61.205 FTYROW while entering roadway from private driveway, ref
RCW 46.30.020 No valid proof of insurance, ref rcw 46.20,015 Driving with no valid license and ref
RCW 46.16A 020 Expired vehicle registration more than 2 months.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 7/17/2024
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REPORT NO. EE97377 CASE# ' 24-7450 DATE AND TIME 07/16/24 15:20
OF COLLISION
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