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HomeMy WebLinkAbout24-6205 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE86421 170 27 COLLISION REP FIT 1591971 CASE 24-6205 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HIT& F ❑ LOCAL AOENC 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28 UNITS RESERVATION I I STRUCK z 3❑ DATE dF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION: 06 - 1-- 2024 2304 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BENSON DR S BLOCK NO. e✓ 17200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 .❑ FEET e S ❑ W e SE 172ND ST ❑ � 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2485687513 0 11 30 6� LAST NAME AYERS FIRSTNAME MADELYN MIDDLE M 1 2 31 INITIAL STREET ❑ 1455 S PUGET DR CITY RENTON ST WA ZIP 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ D RI VERS STATE WA SEXI F MM DAY' 10 — O6 — 2002 1 2 32 9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H USE ET 2 CLASS'NJURY7 [NATURE OF STIFF NECK DRIES z❑ 3 LICENSE CLG7739 sTArr WAurN# 2GNAXSEV2J6110371 10 F91 PI ATE# IT STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM TO TRLR. TRLR 7 1 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34 13 2 2018 CHEV EQU/NO UT DAMAGE vEs 0NO f �LAWkkRS vEs❑ No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO CONNECT BX 13329155 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 4AO424882 FAIL STOP AT STOP 10 BOTTOM 15❑ STANDING 7 6 MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:2533347279 VEHICLE CYCLE OWNER YES�/ NO 16 a LAST NAME ALI ZADA FIRST NAME SHURAB MIDDLE INITIAL 17 STREET NEW ADOREs7 29638 130TH WAY SE CITY AUBURN ST WA ZIP 98092 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NOF 19 LDI IVERI # STATE WA SEX M M D.O.B. 02 _ 01 1997 39 20 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H EET 2 NJAU SY 7 SPLIT LIP,F—NATURE OF I AND INJURED RIGHT LEG NJUR Es 40 LICENSE I ❑21❑ PLA E# CKR9111 TArE WA VIN# 41 STDACAB52RS005589 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. N#. 43 RLR 'I VEH YEAR 2024 MAKE TOYT MODEL GRAND STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO SHURAB ALI ZADA 29638130TH WAY SE AUBURN WA 98092 D:2533347279 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY 41105-09815-62 9TOP 5 IN EFFECT VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N 25 a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEITH PETTY 12809 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE86421 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6205 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 POS. 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' 24-6205 TRAFFIC COLLISION Madelyn M Ayers (DOB 10/06/2002) was driving her white 2018 Chevy Equinox (CLG7739/WA) (Unit 1) and, Shurab Ali Zada (DOB 02/01/1997) was driving his white 2024 Toyota Grand Highlander (CKR9111/WA) (Unit 2). Both drivers were identified by their WADL photo. Unit 1 was on SE 172nd St turning left onto Benson Dr S heading north. Unit 2 was heading north on Benson Dr S in the number 2 lane. Unit 1 advanced into the intersection of Benson Dr S and SE 172nd St colliding into unit 2. 1 cited unit 1 with (RCW 46.61.190) Vehicle entering stop or yielding intersection. RRFA responded due to the airbag deployment and advised both parties to be seen by a doctor for follow up. Shurab was limping from pain in his right leg and had a split upper lip. Madelyn complained of a stiff neck and had minor blood from her nose. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct to the best of my knowledge. Electronically signed: K.Petty, Date: 06/13/24t approximately 0053 hours Place: Renton, King County, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEITH PETTY 06-13-24 01:14 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 6/13/2024 4:45:28 PM BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED; 11:06 PM TIME POLICE ARRIVED',11:08 PM PART I PAGE IT]OF REPORT NO. EE86421 CASE# 24-6205 DATE AND TIME 06/12/24 23:04 OF COLLISION � \'�# �'`"+... �`Sir;�S iti,•:,�8 t�t;"° '7� 4 7 i�� � �.,� i i2}i s� �it2 tst � �;+ S� �..� �« � �� � 't dt e�2c��,�t•: s � i� �t� �taY�.;;#!I,. ..��. to 1 Z 2 4 t 4 r 4 S �t '�;hvta s 1 t a PAGE 3 OF 3