HomeMy WebLinkAbout24-12556 IT �iNII I IIII �� I I III I I IIII IIIII I 27c REPORT NO.STATE OF
COLLISION REPORT 1591971
CASE# 24-12556 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCALAGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 12 - IN
06 - 2024 1735 17 �.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
PARKAVEN BLOCK NO. e 100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 .F--1 FEET e✓ S 8✓ e NO ST
MILES N W NORTH SECO
1 11
29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:6513919690 0 1 30
6❑ LAST NAME ABDULQADIR FIRST NAME ABDULHAFID MIDDLE S 1 2 31
INITIAL
STREET ❑ 8532 S 118TH ST
NEW ADDRESS CITY I SEATTLE ST: WA ZIP: 981784023 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTEd 3
INTERLOCKYES No✓ INTERLOCICYEs NO✓ YES No�/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' O6 — O6 — 1984 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
10 LI ENSE' ARN0709 STATE WA VIN# JTDKN3DU6B1362467 3
11[-j—] TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR zRLR 9 1 33
12 0 o VIN#' VIN#
FROM TO
VEH.YEAR 2011 MAKE TOYT MODEL pRIUS STYLE VEHICLE TOWED fn TO ZBUN TOWEBBY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO NASRA FARAH 30340120TH AVE SE AUBURN WA 98092 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 14 ALLSTATE 8208369786
IN EFFECT &POLICY#V""' CHARGE 36
LEGALLY YES❑NO❑ CITATION# <14,
15 STM ING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:3608369786
16�
LAST NAME DILLARD FIRST NAME JUDITH MIDDLE M
INITIAL
17F1 STREET ❑
❑ 525PELLYAVEN CITY' RENTON ST, WA ZIP 98057 q 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPt7RTED 38
INTERLOCKYES NO✓ (NTERLOCI£YEs NO✓ YES NO✓
19 DRIVER'S
MMDDYYj I —
20❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS COMPLAINT OF BACK/NECK/LEG PAIN
21[ LICENSE I PATE# CKF5222 rare WA vIN# JF2SKAPC4PH520949 41
22❑ PLATE# STATE PLAAILER
TE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2023 MAKE SUBA MODEL FORESTE STYLE (JT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MYERS vEs No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADFY DAGAREA
LIABILITY INSURANCE[Z INSURANCE CO AARP 55PHS590909
IN EFFECT &POLICY# CDTOP
VEHICLE
❑ ,.I—I CITATION# CHARGE G�760TTOM
HE
YES N`[_
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
BRYAN GROZAV 12489 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO.
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12556
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST FIRST,MIDDLE INITIAL) COOK DANIELLE
ADDRESS&PHONE
4254222487 SEXi F MMDDDYBYYY — C--------�
PASSENGER WITNESS UNIT# ! SEAT AIRBAG RESTR. EJECT HELMET INJURY NRE OF INJURIES
POS. USE CLASS [ATU ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) CRAWFORD DEVYN
ADDRESS&PHONE#
2068875003 SEX' U M Da g
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX I MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I 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.
BRYAN GROZAV 12-06-24 09:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 12/15/2024 7:49:43 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:36 PM TIME POLICE ARRIVED i 5:38 PM
PAST B a Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO.` CASE# 24-12556 DATE AND rI OF COLLISION + 12/06/24 17:35
NARRATIVE
CASE 24-12556
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Friday December 6th, 2024, at approximately 17:36, 1 responded to a 911 call regarding a two-
vehicle collision in the area of Park Ave North and North 2nd St within the City of Renton, King
County, Washington. There were several reporting parties reporting similar circumstances of a two-
vehicle collision with one vehicle flipped over on its roof.
I arrived on scene and contacted the involved driver of unit two Judith M. Dillard (DOB:12.13.1962)
who was laying on the ground outside of her vehicle. Judith was complaining of back, neck, and leg
pain. Judith was examined by Renton fire and later transported to Valley Medical Center for further
treatment. Judith indicated she was traveling north on Park Ave North in the right lane when her
vehicle was struck causing it to flip. Judith's vehicle was towed from the scene since it was
inoperable. Judith had a valid driver's license and insurance.
I contacted the driver of unit one Abdulhafid S. Abdulgadir (DOB:6.06.1984) who pulled into the
parking lot across the street. Abdulhafid indicated he was attempting to pull into traffic from the
private driveway of 148 Park Ave North when he pulled out to far into the lane of travel striking unit
two. Abdulhafid was not inhjdured and his vehicle had minimal front-end damage. Abdulhafid had a
valid driver's license and valid vehicle insurance.
I provided both drivers a SECTOR exchange of information form.
This concludes my involvement in this case.
I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.
Electronically signed by B. Grozav#12489 on 12.06.2024 at 21:31 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. CASE# 24-12556 DATE AND TIME 12/06/24 17:35
OF COLLISION
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