HomeMy WebLinkAbout24-5546 IT ' " . 27POLCERAFFO 1 c REPORT NO EE80528
COLLISION REP FIT
1591971
CASE 24-5546 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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' 05 - 1-- 2024 0009 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a WHITMAN CT NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252746415 0 11
30
6� LAST NAME NGUYEN FIRSTNAME OLIVIA MIDDLE M 1 2 31
INITIAL
STREET ❑ 11812 SE 255TH ST CITY KENT ST WA 2jp, 98030 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CHZ5530 sTArI WAurN# 1N4At3AP5EC322282
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2014 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE 34
13 4 NISS ALTIMA P4 DAMAGE YES NOBS TOWING YES[:] No
✓
3 7
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO ESURANCE COMPANY PAWA-008480413 4
IN EFFECT &POLICY# 9TOP
vECALLv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2063714907
16 a
LAST NAME MOKENON FIRST NAME MESERET MIDDLE K
INITIAL
17❑ STREET NEW ADOREss❑' 5149 S AUGUSTA ST CITY SEATTLE ST WA ZIP 98178 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] DRIVER #
❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 H EET 2 NJAU SY 7 COMPLAINT OF PAIN TO CHEST/REFUSED ❑F—NATURE OF INJURIES 40
❑21❑ PLATE# 0005948862 TArE ID VIN f 41
2HKRM4H72GH676306 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE HOND MODEL CRV STYLE Pq VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS TOWING YES NO
REGISTERED OWNER INFO IMPORT MOTORING.3614 E NEWBY ST STE 111 NAMPA ID 83687 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
'E""Le ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
=ON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12421 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE80528
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5546
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MOHAMUD AYMAN L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
5149 S AUGUSTA ST SEATTLE WA 98178 2063714907 SEX M MMDDYyry 01 - 31 - 1963
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 2 POS 3 AIRBAG 6 RESTR. q EJECT 1 USE 2 CLASS +7 COMFLAINTOF CHEST
PAIWREFUSED
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER [:]WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
24-5546 COLL
On 5/26/2024 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a two-vehicle collision in the intersection of NE 4th St and
Whitman Ct NE Renton/King/WA.
I arrived on scene and located a silver 2014 Nissan Altima WA/CHZ5530, there was damage to the
front passenger side quarter panel. The driver was identified by her WADL as Olivia M Nguyen DOB:
8/30/2002. She advised she was not injured. She said that she was turning left into the Safeway
parking lot when she was struck by the Honda CRV.
I then spoke with the driver of the red 2016 Honda CRV ID/0005948862, she advised she was driving
west on NE 4th with the green light when the Altima turned in front of her causing the collision. The
driver was identified as Meseret K Mokenon DOB: 1/19/1967 by her WADL. There was damage to the
entire front of the CRV.
RRFA responded and evaluated all involved who denied any injuries and refused treatment.
Both vehicles were removed from the scene by Bankers Towing.
Nothing further.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 05-26-24 01:11 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 5/26/2024 9:46:03 AM
BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED; 12:10 AM TIME POLICE ARRIVED'12:12 AM
PART I PAGE 2�OF
REPORT NO. EE80528 CASE# 24-5546 DATE AND TIME 05/26/24 00:09
OF COLLISION
U.
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PAGE 3 OF 3
