HomeMy WebLinkAbout24-5479 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-5479 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 05 - 1-- 2024 1356 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
EAST VALLEYROAD BLOCK NO. e✓ 4200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 4841. 00 FMILES EET e S B W e SW 43RD STREET
0 4 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ,/NO D:2068861996 0 11
30
6� LAST NAME JACKSON FIRSTNAME JAELYNN MIDDLE V 1 1 2 31
INITIAL
STREET ❑✓ 580 8TH AVE NE#204 CITY ISSAQUAH ST WA 2jp, 98029 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CJU6308 sTArI WAurN# KMHD74LFOHU390358
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL I STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13Fal 2017 HYUN ELANTR 4D DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO JAELYNN JACKSON 5808TH AVE NE#204 ISSAQUAH WA 98029 D:2068861996 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9ToP 5
VEwcLE CHARGE 10 BOTTOM 36
YES No clTAnoN# W24011632,W24011632, FAIL STOP AT STOP
15❑ STANDING 8 6
MOTOR PEDAL ''.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062908121
16 a
LAST NAME IBRAHIMI FIRST NAME JAMSHID MIDDLE
INITIAL
17❑ NEW STREETRE57 822 S 326TH ST CITY FEDERAL WAY ST WA ZIP 980035935 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YYEEsI I I NOF YEs t l NO�
19� D IVEW # STATE WA SEX M M D.O.B. 03 �_ 24 1999 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# BRU6850 TArE 41
WA VIN# JTDBU4EE169155163 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2011 MAKE TOYT MODEL COROLL STYLE 4p VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMSHIDtBRA.822S326THST FEDERAL WAY WA 1.03 D:2062908121 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 978 917 992IN 1QDVE""LE
9TOP5
❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`L J
25 s a
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE79891
COLLISION REPORT III III III III III 111
1591972 CASE# 1 24-5479
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
PM 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.
MATTHEW NUGENT 05-23-24 04:15 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 5/23/2024 6:10:20 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 2:00 Pry TIME POLICE ARRIVED',2:10 PM
PART I PAGE IT]OF
REPORT NO. EE79891 CASE# 24-5479 OF COLLISION
05/23/24 13:56
OF CbLLI510N
NARRATIVE
24-5479
On 05/23/2024 at approximately 1401 hours, I was dispatched to a non-injury and non-blocking
vehicle collision in the 4200 block of East Valley Road, within the City Limits of Renton, County of
King, State of Washington.
Upon my arrival, 1 confirmed there were no complaints of injury requiring immediate medical response
at the time of report. While on scene, I was able to collect each involved party's information and
independent summary of the events leading up to the collision.
The driver of Unit#1 stated she was the sole occupant of her vehicle and was attempting to exit a
private property parking lot, located in the 4200 block of East Valley Road, on the east side of the
roadway. The driver of Unit#1 stated that she was intending to make a left turn out of the parking lot
with the intent to proceed southbound onto East Valley Road following the turn. The driver of Unit#1
said she believed all traffic on East Valley Road was clear and therefore proceeded out into the
roadway. As Unit#1 pulled out in the roadway, Unit#1 was met by another vehicle - Unit#2. The
driver of Unit#1 stated that she was unable to avoid the collision after having pulled out into the
roadway and that both vehicles collided causing moderate damage to the front passenger side
bumper/fender/headlight of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and was traveling southbound in
about the 4200 block of East Valley Road approaching the intersection of SW 43rd ST in lane 2 of 2.
The driver of Unit#2 stated that while traveling southbound, Unit#1 turned into his vehicle from the
east side of the roadway. The driver of Unit#2 stated he was unable to avoid the collision and that
both vehicles subsequently collided in the roadway causing moderate damage to the rear driver's
door of Unit#2.
Based on the above statements, 1 believe that the driver of Unit#1 (Jackson) was the predominant
factor for the cause of collision as Jackson is required to comply with RCW 46.61.190(2) which states
that every driver of a vehicle approaching the point nearest the intersecting roadway where the driver
has a view of approaching traffic of the intersecting roadway must stop before entering the roadway,
and after having stopped shall yield the right-of-way to any vehicle in the intersection or approaching
on another roadway so closely as to constitute an immediate hazard during the time when such driver
is moving across or within the intersection or junction of roadways. Unit#2 was already underway in
the roadway and had right of way.
A DOL WACIC check revealed that Jackson was listed as License status Suspended in the Third
Degree. Jackson also admitted to me that she did not have proof of motor vehicle insurance.
Jackson was Driving While License Suspended in the third degree by operating a motor vehicle at a
time when her license is suspended in the third degree.
I issued the driver of Unit#1 (Jackson) a correction notice in-person for failure to comply with RCW
46.61.190(2), DWLS 3rd Degree, and Operating a Motor Vehicle without insurance. Jackson has
been instructed to get her licensed cleared and back into valid status as well as obtain proof of motor
vehicle insurance in the next 30 days otherwise she will be cited for the above-mentioned violations.
Both vehicles were able to be driven away without further incident. An exchange of information was
provided to all involved parties.
I certify (or declare) under penalty of perjury under the Law of the State of Washington that the
foregoing is true and correct.
PAGE 3 OF 5
REPORT NO. EE79891 CASE# 24-5479 OF COLLISION
05/23/24 13:56
OF CbLLI510N
NARRATIVE
Electronically signed by Officer M. Nugent#11498 5/23/2024 4:05 PM Renton, King County, WA.
PAGE 4 OF 5
REPORT NO. EE79891 CASE# ' 24-5479 DATE AND TIME 05/23/24 13:56
OF COLLISION
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PAGE 5 OF 5
