HomeMy WebLinkAbout24-4107 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-4107 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: 04 — 1—— 2024 0905 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FMILES EET e S ❑ E e BREMERTON AVE NE
0 1 29
R PEDAL- DAMAGE
MOTO THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO F/ I D:2067014266 0 11
30
6❑ LAST NAME ABDI FIRSTNAME DHIMBIL SAMA TAR MIDDLE 1 1 2 31
INITIAL
STREET ❑ 14218 3TH AVE S APT 9 CITY TUKWILA ST WA 2jp, 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
$ LDIRIVERS CENSE# STATE I WA SEX M MMDDYY 1 01 - 01 - 1953 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� BZP1653 sTArI WAVIN# JTDKN3DU7F1868766
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 3 2015 TOYT PRIUS 4H DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO DHIMBIL SAMATAR ABDI 142183TH AVE S APT 9 TUKWILA WA 98168 D:2067014266 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI V INSURANCE[Z INSURANCE CO HUMBLE INSURANCE GROUP INC BAP0779056.02 3 4
IN EFFECT &POLICY# 9TOP
LE Yes CHARGE 5 36
LECAvEHICLLv ❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2067184096
16 a
LAST NAME PHELPS FIRST NAME SHANNON MIDDLE K
INITIAL
17 STREET❑ NEW ADDRESS❑' 14302 148TH PL SE CITY' RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19 F] DRIVER'S STATE WA ]SEX IF D.C... 03 _ 29 _ 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES 40
USE CLASS BLOODYNOSE
❑LICENSE I 21❑ PLA E# CCP9676 TArE 41
WA VIN1 1V2AR2CA1NC529875 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE VOLK MODEL ATLAS STYLE SV VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO SHANNON PHELPS 14302148TH PL SE RENTON WA 98059 D:2067184096 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 368 9479-BO1-47GIN 1 9TOP
vEH'CLe ❑ ,J� CITATION# CHARGE
25 BOTTOM
LEGALLY YES N J
$ '
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 SWAN 7 12965 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68257
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4107
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.
NICHOLAS SWAN 04-15-24 10:25 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 4/15/2024 11:45:34 AM
BADGE OR ID# 12965 ORI#' WA0171300 TIME POLICE DISPATCHED; 9:07 AM TIME POLICE ARRIVED',9:17 AM
PART Ei PAGE IT]OF 4�
REPORT NO. EE68257 CASE# 24-4107 OF COLLISION
04/15/24 09:05
OF CbLLI510N
NARRATIVE
On 04/15/2024 at approximately 0907 hours, I was dispatched to a non-injury blocking two-vehicle
collision at the 4400 block of Bremerton Ave NE, within the City Limits of Renton, County of King,
State of Washington.
Upon arrival, I contacted the involved parties and confirmed no injuries had occurred requiring
immediate medical response at the time of report. There, I collected the involved parties driving
documents and their independent recollection of events leading up to the collision.
The driver of Unit#1 said he was traveling eastbound on NE 4th ST. The driver of Unit#1 stated he
was traveling in his lane when Unit#2 stopped in front of him while he was driving in his lane. The
driver of Unit#1 stated that the driver of Unit#2 stopped quicker than he was expecting and
attempted to stop his vehicle in time but was unable to and subsequently collided with the rear of Unit
#2.
The driver of Unit#2 said she was the sole occupant of her vehicle and also traveling eastbound on
NE 4th St. The driver of Unit#2 stated she slowed and then stopped to let a vehicle in front of her turn
in to the Key Bank parking lot. While Unit#2 was slowing and stopping, Unit#1 collided with the rear
of Unit#2 causing moderate damage to the rear bumper of Unit#2.
Based on the above statements, I determined that the Driver of Unit#1 (Dhimbil) was the
predominant factor for the collision due to inattention causing a collision. Dhimbil should have been
paying closer attention to the movement of traffic in front of him.
Unit#1 was able to be driven away without further incident. Unit#2 also drove away without further
incident. No citation was given to either party. 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 N. Swan #12965 1008 hours on 04/15/2024 in Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EE68257 CASE# 24-4107 DATE AND TIME 04/15/24 09:05
OF COLLISION
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