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COLLISION REP FIT 1591971
CASE 24-11362 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4300 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.. 11 — 01 — 2024 1624 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LIND AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2064131395 2 01
30
6� LAST NAME GHAFARI FIRSTNAME MEHDI MIDDLE 1 1 2 31
INITIAL
STREET ❑1 15310 MACADAM RD S B301 CITY TUKWILA ST I WA 2jp, 98188 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 03 - 27 - 1945 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE C38918Y sTATI WAurN# 1FTEX15N1RKA74959
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR 1994 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] $ 34
13 2 FORD F150 TR DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO USAA 3 4
IN EFFECT &POLICY# 9TOP
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063131256
16 a
LAST NAME ALTARES FIRST NAME ARMANDO MIDDLE R
INITIAL
17❑ STREET ❑', 12637 SE 161ST ST CITY' RENTON ST WA ZIP 980585325 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 LDI IVEW # STATE WA SEX M M .C... 09 _ 13 _ 1957 El 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BTA3206 TATE WA VIN# SHHFK7H24HU232955
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2017 MAKE HOND MODEL CIVIC STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO ARMANDO ALTARES 12637 SE 161ST ST RENTON WA 980585325 D:2063131256 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ESURANCEPAWA7783591IN STOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
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. EF43957
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11362
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ALTARES NORALYN R
(LAST FIRST,
ADDRESS&PHONE# D O.B.
12637 SE 161 ST ST RENTON WA 980585325 SEX F MMDOYyry 05 - 17 - 1961
PASSENGER Z WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 1 EJECT ? HELMET INJURY NATURE OF INJURIES
USE 1 2 CLASS i1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 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.
C.CATALAN 11-05-24 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 12/9/2024 12:41:48 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 4:27 Pry] TIME POLICE ARRIVED',4:44 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EF43957 CASE# 24-11362 OF COLLISION11/01/24 16:24
NARRATIVE
On November 1, 2024, at approximately 1624 hours, I was dispatched to a vehicle collision at the
intersection of SW Grady Way and Lind Ave SW, within the City Limits of Renton, County of King,
State of Washington.
Upon my arrival, I confirmed there were no complaints of injury requiring immediate medical response
at the time of report. There, I was able to contact the driver of unit 2, but unit 1 was gone upon my
arrival.
The driver of Unit 2 was accompanied by his front passenger. The driver stated he was traveling
eastbound in about the 400 block of SW Grady Way and approaching the intersection of Lind Ave SW
in lane 2 of 2. The driver of Unit 2 stated he was intending to make a left turn. As they entered the left
turn lane, Unit 1 changed lanes from behind him them from lane 2 of 2 and into left turn lane which
Unit 2 was almost occupying. The driver of Unit 1 then sped up and subsequently collided with Unit 2.
Unit 2 suffered minor damage to the front bumper due to the collision. The driver of unit 2 mentioned
that the driver of unit 1 was in a rush to the hospital. After the collision occurred, the driver of unit 1
told the reporting party to call the police and mentioned he needed to leave.
Later, the driver of Unit 1 requested a phone call from me. The driver wanted to explain how the
collision occurred. He said he was the sole occupant of his vehicle and said he was traveling
eastbound in about the 400 block of SW Grady Way and approaching the intersection of Lind Ave SW
in the left turn lane. The driver of Unit 1 stated that while making a left turn, the driver of unit 2 merged
left and struck him. Unit 1 said he was already occupying the left turn lane. Unit 1 and unit 2 collided
in the left turn lane causing no damage to the wheel of Unit 1.
I was unable to determine who committed the traffic violation. This will be an informational report
only. An exchange of information was provided to the involved parties.
PAGE 3 OF 4
REPORT NO. EF43957 CASE# 24-11362 DATE AND TIME 11/01/2416:24
OF COLLISION
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PAGE 4 OF 4
