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HomeMy WebLinkAbout24-10151 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF22171oc� RA COLLISION REPORT 1591971 CASE# 24-10151 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCALANG 3 HIT&RUN C©DIN6 COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 09 - 28 - 2024 1327 17 =.[� S 8 W e IN OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ PARKAVEN BLOCK NO. e 400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e N 4TH ST 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064681867 0 1 30 5 LAST NAME AHMED FIRST NAME NAVEED MIDDLE t 1 2 31 INITIAL STREET ] 3815 NE 4TH ST APT E162 CITY; RENTON ST I WA ZIp; 98056 2 NEW ADDRESS 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3 INTERLOCKYEs No�/ INTERLOCKYEs NO�/ YEsF NoF,/ 8 DRIVER # STATE WA SEXI M MMDDYY' 03 — 22 — 2007 1 2 32 9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 JHELM USEET 2 CLASSY ? NATURE of INJURES 2 LICENSE, CMR4431 STATE WA VIN# 7SAYGDEE7RF088430 3 10 as ATP tt TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM TO TRLR TRLR. 3 7 33 12 0 0 VIN#' VIN# FROM TO 13 4 VER YEAR 2024 MAKE TESL MODEL MODEL STYLE SO VEHICLE TOWED 2 TO fjBUN TagWgYMEYER GOV jFNo 5 1 34 DAMAGE IIII._IIII I_I REGISTERED OWNER INFO OMAR PASHAAHMED 3815 NE4TH STAPTE162 RENTON WA 98056 D:2064681867 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 ALLSTATE 820776233 IN EFFECT &POLICY# 4TOP VEn" CHARGE 5 36 Lemur YES❑NO❑ CITATION# 7 0 80TTOM 15❑ STM ING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2068548180 16� LAST NAME LAIS FIRST NAME HELEN MIDDLE F INITIAL 17 F1 STREET ❑ ❑ ?150 USE 173RD ST CITY'.. RENTON ST, yyq ZIP 98055 37 NEW ADDRESS 18❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTEO' ❑ 38 CDL INTERLOCKYES NO INTERLOCK YES ElNo YES NO 19 DRIVER'S STATE WA SEX F I D.O.B. 05 20 1946 39 LICENSE# MMDDYY HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 2 7 ❑ USE CLASS SHORT OF BREATH,TAKEN TO VMC 21 LICEN� ATZ0357 raTE WA vIN# JTMRFREV3FD115479 41 PLATE 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# VEH.YEAR 2Q15 MAKE TOYT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYER E REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NQ.2 SHADFY DAMAGED AREA 3 4 LIABILITY INSURANCE INSURANCE CO AARP 55PHT522738 IN EFFECT &POLICY# 9TOP vewae ❑ ,J—I CITATION# CHARGE t080TTOM EEGnEEY YES N 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 JOSEPH SINGER 12056 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF22171 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10151 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) SALGADO—URBINA LUIS O ADDRESS&PHONE# D� 1633 HARRINGTON AVE NE RENTON WA 98056 2066364447 SEXi M MMDDYVYv 09 — O6 — 2006 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES �; 1 POS. 3 2 4 1 USE 2 CLASS 1 �----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS R PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY: NATURE OF INJURIES POS. USE O'SS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Vehicle 1's driver admitted he had not seen the red light and proceeded to drive west on N 4th ST, through the red light, across Park Ave N. Vehicle 2 had a green light while driving north on Park Ave N. Vehicle 2 T-boned vehicle 1 in the intersection. Vehicle 1's passenger and a witnessed advised of similar stories. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JOSEPH SINGER 09-28-24 02:15 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE DESIREE SCOTT 10272 10/7/2024 11:33:35 AM BADGE OR ID# 12056 ORI# WA0171300 TIME POLICE DISPATCHED 1:28 PM TIME POLICE ARRIVED i 1:34 PM PAST B 3 Da-3mx—attar gt 1Mffp PAGE 2�OF F3 REPORT NO. E F22171 CASE# 24-10151 DATE AND TIME 09/28/24 13:27 OF COLLISION i a}S 4 lts- a � 4} is l F, S 3 , J i �t ss }}3i �Y 1. ' !% p t` t 6, 1 t IF �f } PAGE 3 OF 3