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HomeMy WebLinkAbout24-6372 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EE92196oc� RA COLLISION REPORT 1591971 CASE# 24-6372 2 INTERSTATE CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL CO AGENCY. 4250 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TOTAL 1 TRIBAL UNITS#OF 03 SO BJECT TRUCK 1 8 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulSloN' 06 - 17 - 2024 1729 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ NE SUNSET BLVD BLOCK ST e 4a MILE POST 2400 .� ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET H S 8 W e SUNSET BLVD NE 2 0 29 PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLMOTtlRE ❑ CYCLE' ❑ YES NO F/ D:2066379812 0 1 30 5 LAST NAME SHEIKHADEN FIRST NAME MUMTAZ MIDDLE A 1 1 2 31 INITIAL STREET ❑ 11436 RENTON AVE S NEW ADDRESS CITY SEATTLE ST WA ZIP 981783042 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NOR] INTERLOCKYEs NO�/ YES D No Z 8 DRIVER'S STATE WA SEX F MMDC)YY' 12 — 25 — 2003 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET CLASS 1 NAruRE of INJURIES 2 10 LI ENSE'ti�' BUZ8147 STATE WA VIN# 1C3CDFAA9GD738690 3 TRAILER STATE TRAILER ,STATE 11 3 5 PLATE# PLATE# FROM TO TRLR TRLR 3 7 33 12 3 5 VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE 13 4 2016 DODG DART DAMAGE vesNo ✓ ves❑ No 3 7 34 REGISTERED OWNER INFO ABDIRIZAKDIRIR3703 S EDMUNDS ST#49 SEATTLEWA98118 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE❑ INSURANCE CO 2 3 4 14 THE GENERAL 53WA6660559 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE 5 36 Lemur yes[:]NO[:] CITATION# 7 0 80TTOM 15❑ sTnNowc s 7 MOTOR PEDAL PHONE UNIT 02 PEDESTRIAN PROP D:2 155969272 nWNFR 16� LAST NAME YAR FIRST NAME HOOMAN MIDDLE I N INITIAL 17 F1 STREET ❑'❑ 4408 NE 25TH CT CITY RENTON ST, yyq ZIP 37 980593535 NEW ADORESS 18 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38 INTERLOCKYEs No INTERLOCKYEs NO vEs No;� 19 DRIVER' # STATE WA SEK,M MD.MDDW 09 11 1988 39 HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSLATE E CKE4707 TATE WA vIN# 7SAYGDEElPF839079 41 22❑ [TILER TRAILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2Q23 MAKE TESL MODEL MODEL Y STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO HOOMAN YAR 4408 NE 25TH CT RENTON WA 98059 VEHICLE NO.2 SHADE DAGED AREA 4 LIABILITY INSURANCE INSURANCE CO TESLA 543191BA2847 IN EFFECT &POLICY# 9TOP vewaE ❑ ,.I—I CITATION11 CHARGE 1060TTOM LecnLLr YES N J 25 a a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EE92196 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6372 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME Ll YUEYI N (LAST,FIRST MIDDLE INITIAL} ADDRESS&PHONE# D 4408 NE 25TH CT RENTON WA 980593535 SEX' F MMDDvvvv 08 — 28 — 1990 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES El 2 POS. 3 2 4 1 USE CLASS 11 NATU 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# S ' D.O EX .B.MMDD —F L----------� YYYY EAT HELMETNJURY URE OF PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL ADDRESS&PHONE# SEX' D.O.B.M —T L----------� MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----� NARRATIVE All three vehicles driving westbound along 2400 block of NE Sunset Blvd at the intersection of Sunset Blvd NE. Unit 3 makes illegal lane split/overtaking manuver and drives in between Units 1 and 2 causing non reportable non disabling rear driver side damage to Unit 1 and non reportable non disabling passenger side damage to Unit 2. Unit 2's damage was not noticeable on scene save for a small silver dollar sized gouge out of the tire tread on the front passenger side tire. Unit 3 does not remain on scene and leaves westbound towards 1-405. No injuries. No persons involved could positively identify Unit 3 driver. Unit 3 reportedly a white SUV possible a Toyota 413unner. Unknown license plate. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 06-17-24 08:21 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY E DAT P.SUMMERS 8887 71212024 4:46:59 PM BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:02 Pry/ TIME POLICE ARRIVED 6:09 PM PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 47 SUPPLEMENTAL REPORT No. EE92196 POLICE TRAFFIC 1 0 6 27 µ ^'� COLLISION REPORT CASE#+ 24-6372 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD. GWUR '. NAME IF NO NUMBER SOURCE AXLES 1:1 + 4a ❑ ADDITIONAL UNITS ,µ MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE UNIT# ' 3 PEDESTRIAN �', YES NO 5 VEHICLE CYCLE OWNER F,/ 0 2 29 LAST NAME UNK FIRST NAME MIDDLE INITIAL STREET pl 30 CITY RENTON ST ZIP NEW ADDRFS 6 6 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPOR7ED INTERLOCK YES. NO INTERLOCK YEs NO DRIVER'S STATE SEX U MD'O BYY —�— LICENSE; 7 ON DUTY STATUS: AIRBAG 2 RESTR. 9 EJECT 1 HELMET 9 INJURY 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE.:UNK rAr WA VIN# UNK PLATE# 9 TRAILER TRAILER 2 PLATE#t STATE PLATS# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR MAKE UNKN MODEL UNK STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO.UNK UNK RENTONWA98056 3 7 33 12 � SHADE IN DAMAGED AREA 4 FROM TO LIABILITY INSURANCE❑ INSURANCE CO }Zt)P IN EFFECT &POLICY# 1 "^"^"-- 3 m 34 13 venic�e YES NO CITATION# CHARGE 10 NOTTC)M ecaLLY sTnNoiNc 3 7 ti MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME NIIT ALE MIDDL ❑ 16 ❑ STREET CITY ST ZIP NEW ADDRESS GDL IGNITION REZ RED 1GNITION PRESENT MEDICAL TANSPORTED INTERLOCK YES NO INTERLOCK YES NO 'YES NO 17 37 LLIRIVERS ICENSE# STATE SEX MMDDwY' —� 18 ❑ HELMET INJURY NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS 19 ❑ ❑ 39 LICENSE rAT vIN PLATE# 1 # 20 ❑ TRAILER TRAILER ❑ 40 PLATE#. STATE PLATE# STATE 21 ❑ TRLR TRLR 41 UIN# VIN# 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE I INSURANCE CO IN EFFECT &POLICY# tK-99 5 44 vewc�e ❑ ❑ CITATION# CHARGE 24 ITGA VES NOSTWN3 3 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 06-17-24 08:21 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE 1 OR ID# 12651 O#RI WA0171300 APSUMMDERS 71212024 PAGE[3 OF 3000-345-013(R 11l18) REPORT NO. EE92196 CASE# 24-6372 DATE AND TIME 06/17/24 17:29 OF COLLISION NE Sun Not To PAGE 4 OF 4