HomeMy WebLinkAbout24-853 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# z4-ss3 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 5 6 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 01 - 1-— 2024 1405 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ VV a MORR/S AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2068868283 0 11
30
6� LAST NAME LUONG FIRSTNAME DIEM MIDDLE K 1 1 2 31
INITIAL
STREET ❑ 5113 NE 10TH PL CITY RENTON ST WA 7jp, 980594367 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� AXD7869 sTArI WAvIN# 2HKRM4H75FH683510
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FR.. ro
TRLR. A'RLR. 1 1 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 $ 34
13 2 2015 HOND CR-V DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO SUU NGUYEN 5113 NE 10TH PL RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ENCOMPASS 283 045481 3
IN EFFECT &POLICY# 9TOP
VE—L' CHARGE 1 5 36
LEGALLY, YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067309138
16 a
LAST NAME SAMADI FIRST NAME HASEEBULLAH MIDDLE N
INITIAL
17❑ STREET ❑', 23240 88TH AVE S APT W203 CITY KENT ST WA ZIP 980313194 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CFW5348 TAre WA VIN# JTDK820U150118440
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TIN# IN RLR
#.UIN#. '
VEH YEAR 2005 MAKE TOYT MODEL PRIUS STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO HASEEBULLAH SAMADI 2324088TH AVE S APT W203 KENT WA 98031 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 965315034IN STOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
25 io BOTTOM
LEGALLY YES ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE44311
COLLISION REPORT III III III III III 111
1591972 CASE# 24-853
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'
blue prius eb lane 1 blk suv sb
RTF
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of S
3rd St at Morris Ave S.
I contacted the driver of unit 1 who told me she was south on Morris on her green light when unit 2
stuck her car, spinning her out. She did not complain of injury. Damages required a tow truck, but
when the tow truck arrived she wasnt sure if she wanted to have her car tow or not.
I contacted the driver of unit 2 who told me he was east on S 3rd St lane 1 and said his light was
green when he contacted unit 1. He did not complain of injury and damages required a tow truck.
Opposing traffic signals can not be green at the same time. No witnesses to corroborate and local
business camera did not capture the crash. Insurance/information only.
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 1/24/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 01-24-24 02:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1/25/2024 1:41:56 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED Y:05 Pry TIME POLICE ARRIVED',Y:08 Pry
PART I PAGE IT]OF 3�
REPORT NO. EE44311 CASE# 24-853 DATE AND TIME 01/24/24 14:05
OF COLLISION
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