HomeMy WebLinkAbout23-4750 ("7—
STATETFFi "CE RA II (II IIII I III I I IIII III II I 0 27c .
,one COLLISION REP F 1591971
CASE# 23-4750 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK 1 8 OBJECT 2$
RESERVATION 1 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
COAT sloN 04 - 27 - 2023 1236 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE4THST BLOCK NO. 8✓ 3200 .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 50 00 FEET e✓ S e W V MONROEAVE NE
2 0 29
M070R PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YEs ,/NO D:7409531430 0 1 30
6 LAST NAME HAX FIRST NAME YUSUF MIDDLE 1 2 31
INITIAL
STREET E:1' 3020 S 154TH ST APT D223 CITY SEATAC ST I WA ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs Noy/ INTERLOCKYEs No YES Na,/
8❑ LICENSE STATE OVA SEX'M MM flYY 10 - 19 - 1994 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U5 E7 CLASS 1 NATURE OF INJURIES 2
LICEN st CGH1851 STATE WA WIN# JTDKN3DUXB1476164 3
10 1❑ PI
11 3 5 PLATE# STATE TRAIPLATE# STATE ROM To
RA
TRLR TRLR. 7 3 33
12 3 5 vIN#' VIN#
FROM TO
13 2 VEH.YEAR2011 MAKE TOYT MODEL PRIUS STYLE VEHICLDAMAGE TOWED Ftl T02fBLIN TOWED BY GOVT.VEHIICLNOF✓ 7 3 34
❑ REGISTERED OWNER INFO ABNINASIR HASSAN 1414S 120TH ST SEAT7LEWA 98168 IL—llll VEHICiLE cNJIIOO..'II1
SHADE 1N DAMAGED AREA ❑ 35
2 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 GEICO REN3270751
IN EFFECT &POLICY# 4TOP _
vtwCLL CHARGE i 5 ❑ 36
EGALl v YES[:]NO[:] CITATION# 10 BOTTOM
15❑ --Nc 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE OWNER YES NO D:2065509113
16�
LAST NAME RIGAZIO FIRST NAME BETHANIE MIDDLE A
INITIAL.
17❑ STREET El 375 UNION AVE SE UNIT 109 CITY RENTON I ST, WA I ZIP 980595171 37
NEW ADDRESS I ❑
18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED ❑ 38
W7ERLOCKvF Now INTERLOCkCvEs NO YES No,�
19 DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N U MEET URY CLASS 1 NATURE OF INJURIES 40
21❑ LICENSE I C74567L TATf WA vIN# 1FM5K8687HGD56817
❑ 41
PLATE#
TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2017 MAKE FORD MODEL EXPLORE STYLE DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
O
24 YES
REGISTERED OWNER INFO BETHANIE RIGAZl013616161ST PL SE RENTON WA 98059 VEHICLE NO.2
SHAD DAGAREA
LIABILITY INSURANCE INSURANCE CO SAFECOX6209474
IN EFFECT &POLICY# t STOP 5
venue ❑ .1-1 CITATION# CHARGE tO BOTTOM
�ecn��v YES N J
25 B � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
CO.JOHNSON 0505 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED57534
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4750
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) GULED ABSHIR
ADDRESS&PHONE
7637428017 SEXi U MMDDDYBYYY - C--------�
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z ❑; 1 POS. 13 2 4 1 USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL) OSMAN ABDIRIZAK
ADDRESS&PHONE#
2063307900 SEX' U M oa eYr
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS❑!UNIT# 1 PEA 9 AIRBAG 1 RESTR. 4 EJECT 1 USE CLASS 1 ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX/ D.O.B. -
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I 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.
CO.JOHNSON 04-27-23 05:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 51512023 6:52:40 PM
BADGE OR ID# j 0505 ORI#' i WA0171300 TIME POLICE DISPATCHED 12:43 PM TIME POLICE ARRIVED i 12:54 PM
PART B 35e0-345.160(R1Vt8) PAGE 0 OF 47
REPORT NO.1 ED57534 CASE# 23-4750 OF DATE AND LONE 04/27/23 12:36
OF COLLISION
NARRATIVE
U2 EB NE 4th left turn lane to NB Monroe Ave NE; U1 EB In #2 NE 4th changed lanes into turn lane
and collided with U2
On 04-27-2023 at about 1243 hours I was dispatched to a collision in the area of NE 4th St and
Monroe Ave NE in the City of Renton, County of King, Washington. There were no injuries reported
and the vehicles had moved into a nearby parking lot. I arrived in the area at about 1254 hours.
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. Unit 02 was
east bound in 3200 block of NE 4th St, in the left turn lane with the intent to turn left (north) onto
Monroe Ave NE. The driver said Unit 01 came into the left turn lane and collided with her vehicle.
The driver of Unit 01 provided a picture of a WA DL on a cellular telephone and admitted to driving
the listed vehicle. Upon checking DOL records, the driver of Unit 01 resembled the picture on the
DOL return. The driver said he changed lanes into the left turn lane when his vehicle collided with
Unit 02.
There was moderate damage to the driver side fender of Unit 01 and moderated damage to the
passenger side of Unit 02. The damage was consistent with the information provided by both drivers.
Based on the small area of damage to Unit 01 when compared to the large area of damage of Unit
02, it appears Unit 02 was moving forward when the collision occurred.
The proximate cause of the collision was Unit 01 changing lanes and failing to yield the right of way to
Unit 02 which was already established in the lane of travel. Were it not for the actions of the driver of
Unit 01, the collision would not have occurred.
No citations or infractions issued. Report for information and insurance.
PAGE 3 OF 4
REPORT NO. ED57534 CASE# 23-4750 DATE AND TIME 04/27/2312:36
OF COLLISION
Monroe Ave NE
NE 4th St
i
"Not to Scale**
PAGE 4 OF 4
