HomeMy WebLinkAbout24-1599 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-1599 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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#
COLLISION'. 02 - 1-— 2024 1512 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2533976171 0 3 30
6� LAST NAME WOOD FIRSTNAME GARY MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 18806 MEADOW LAKE RD CITY SNOHOMISH ST WA Zjp, 982907218 z
NEW ADDRESS
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 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C12783N sTArI WAurN# 1FTBF3A65KED29696
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2019 FORD F350 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO HIGHMARK CONCRETE CONTRACTORS PO BOX 1713 BUCKLEY WA 98321 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE E CO TRAVELERS INSURANCE 8103L5953572426G 4
LI EFFECTISUR N# TOPVEHICLE CHARGE 36
LECALL'Y Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ PROPSOWNE ❑ YES NO ,/ D:4259705476
16 a
LAST NAME AL ABAR FIRST NAME MARWAN MIDDLE M
INITIAL
17❑ STREET ❑' 9624 FRONTIER AVE SE,APT F20 CITY SNOQUALMIE ST WA ZIP 98065 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES t l NO❑
19 D IVEW # STATE WA SEX M M.C.B. O6 _ 11 1983 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS 41
❑
21❑ LICENSE CFW6775 TAre WA vIN1t STDJK3DC26S018357
❑
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE TOYT MODEL SIENNA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO MARWAN AL ABAR 9624 FRONTIER AVE SE UNIT F20 SNOQUALMIE WA 98065 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU8 PORGY#E CO GENERAL INSURANCE 53-WA 6039240 1U
9TOP
IN EFFECT
VE""LE ❑ ,J� CITATION# CHARGE o BOTTOMLEGALYYES N`L J25 '
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE54008
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1599
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'
On February 13, 2024 at 1512 hours dispatch requested that I respond to a collision at SW Grady
Way and Rainier Ave S, in the City of Renton, County of King, and State of Washington.
Upon my arrival, I spoke with the driver of unit 2 and he explained he was struck from behind by unit
1.
I then spoke with the driver of unit 1 and he explained both vehicles were making a right turn from SW
Grady Way onto SR 167. He followed unit 2 closely. As they made their right turn, unit 2 slowed
down. The driver of unit 1 failed to notice them slowing, hitting them from behind.
The driver of unit 2 said he was okay and did not need medical attention. He was emotionally
flustered due to the collision.
An exchange of information was given to both drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-13-24 05:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 2/26/2024 5:03:53 PM
BADGE OR ID# 1Y007 OR]#' ' WA0171300 TIME POLICE DISPATCHED 3:19 PM TIME POLICE ARRIVED 3:30 PM
PART I PAGE IT]OF 3�
REPORT NO. EE54008 CASE# ' 24-1599 DATE AND TIME 02/13/24 15:12
OF COLLISION
1
i
Rainier Ave S, SR 167
SW Grady Way
NITS
i
t
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