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HomeMy WebLinkAbout24-11627 �oLcRaiTFFiN 1 6 27c REPORT NO. EF35257 "i ,tat COLLISION REP F 1591971 "e ❑ ❑ FIRE CASE# '. 24-11627 2 0 7 INTERSTATE CITY STREET RESULTED 1 STOLEN STATE ROUTE � OTHER � VEHICLE � LOCAL AOENC: 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT', 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION '. 2 3 4 M M D D Y Y Y Y TIME r240M couNTv# MILES CITY# COLTN 11 - 08 - 2024 2013 17 =.= S e W e OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION NE SUNSET BLVD BLOCK MILEPOST ST 4a 8✓ 3100 .� ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 50 00 FEET 8 S e W 8 MILES N It NE 12 ST 0 1 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT VEHICLE ___CYCLE YEs ,/No D:4254730525 F 7 30 g LAST NAME MUSLEM FIRST NAME MUKHAMED MIDDLE R j 1 1 31 INITIAL STREET ❑ 300 VUEMONT PL NE APT M203 CITY RENTON ST WA ZIP i 980564539 z NEW ADDRESS 7❑ CDL IGNITION RE(1UR5 IGNITION PRESENT MEDICAL TRANSPORTED 3 tNTERLOCKYFs No 7/ INTERLOCKYEs No�/ YES M NO y/ 8 DRIVERS STATE STATE WA SEX M MMDDYY' 11 — 22 — 2001 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 U SE CLASSY 1 NATURE OF INJURIES z 3 10 9❑ PIATFS# NONE TAT WA vIN# JFIGJAD6XDH011259 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR TRLR 1 5 33 12 3 5 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34 13 4 2013 SUBA IMPREZ SD DAMAGE YES NO YES[—] No REGISTERED OWNER INFO MUKHAMED MUSLEM 300 VUEMONT PL NE APT M203 RENTON WA 980564539 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 F1 LIABILITY INSURANCE❑ INSURANCE CO NONE 4 IN EFFECT &POLICY# 9TOP e icLe CHARGE 10 BOTTOM S 36 ALL rEs No clTanoN# 4AO452433 OP MOT VEH W/OUT INSURANCE, El 15❑ srnNoiNc 7 e MOTOR ,I PEDAL- UNIT PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE CYCLE OWNFi2 YES NO D:5182225425 16� LAST NAME ' WAITE FIRST NAME EL►ZABETH MIDDLE D INITIAL 17❑ STREET", 5206A DELRIDGE WAY SW CITY SEATTLE ST, WA ZIP 1 981061344 ❑ 37 NEW ADDRESS 18❑ ODL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYEs No INTERLOC�£vEs NO✓ YES FNO,Z 19 LDICIENSE# STATE WA SEX F MMDDYY 08 _ 17 1992 39 20 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASS 7 I BACKFAIN3uRIEs 40 21 PLATE# BPB2033 _WA IN# 2T3RFREV6GW415022 41 42 TRAILER 22 PATE# STATE PLATE# STATE 23� 43 TRLR RLR UIN#. 'IN# VEH.YEAR 2016 MAKE TDyT MODEL RAV4 STYLE VEHICLE TOWED TO BLIN TOWED BY GO HI 44 24= DAMAGE YES NO� YES NO REGISTERED OWNER INFO ELIZABETH WAITE 5206A DELRIDGE WAY SW SEATTLE WA 98106 VEHICLE NO.2 SHADE IN DAMAGFR.AREA 2 3 ld LIABILITY INSURANCE ORI N#E CO STATE FARM 5226625CO147 &P IN EFFECT 4TOP veer°Le YES NC[:] CITATION# CHARGE 70 BOTTOM IE—LE 25 s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLICE TRAFFIC" CORRECTION REPORT NO. I EF35257 COLLISION REPORT III III III 111111111 1591972 CASE# 24-11627 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST,RRST MIDDLE INITIAL) ADDRESS&PHONE It SEX MMDDYYYY' PASSENGER[—]WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D a Ei SEX MMDDYYYY PASSENGER F—J WITNESSM UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# sEx D.a.�. MMDDYYYY PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NARRATIVE' Units 1 and 2 both traveling south along the 3100 block of Sunset Blvd NE approaching the intersection at NE 12th St. Unit 2 slowed for traffic. Unit 1 rear ends Unit 2 causing reportable non disabling damage to the rear of Unit 2 and reportable non disabling damage to the front of Unit 1. Unit 2 driver reports back pain and was assessed on scene by Renton Fire. Unit 1 driver admits on scene that he followed to closely to avoid collision. Unit 1 driver cited for following too closely, no vehicle insurance, and defective windshield as the front of Unit 1 windshield was badly fragmented, prior to the collision, and clearly impaired a driver's vision, likely contributing to the driver's proximate cause of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 11-08-24 09:04 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 1111312024 4:22:09 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 8:18 PM TIME POLICE ARRIVED 8:21 Pry] PART IE1 aaaa-acx.,sa(RIVMe PAGE 27 OF 3� REPORT NO. EF35257 CASE# 24-11627 DATE AND TIME ', 11/08/24 20:13 OF COLLISION 1 f S 1 } { S } a 1 Y n i..... { d P u`: PAGE 3 OF 3