HomeMy WebLinkAbout25-546 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF59679 170
27
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 25-546 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 01 - 1-- 2025 1716 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES ❑ S ❑ W e TALBOTT RD S
2 0 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO D:5099894228 0 11
30
6� LAST NAME TASHAKKOR FIRSTNAME MARYAM MIDDLE 1 2 31
INITIAL
STREET 01 2307 NE 4TH ST APT J 306 CITY RENTON ST WA Zjp, 98056 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 1 INJURY CLASS 7—1 [NATURE OF INJURIES HEAD AND NECK PAIN 2❑
❑P1 ATE 14 CHD5015 STATE WA VIN# KMHL54JJXPA056587 3
10❑
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 3 34
13 4 2023 HYUN SONATA 4D DAMAGE YES NOBS YES❑ No✓
REGISTERED OWNER INFO BEHROUZ PARAHBAKHSH 2307 NE 4TH STAPT J306 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE[Z INSURANCE CO ALLSTATE 987271597 3 4
IN EFFECT &POLICY# 9TOP
VE"'c' CHARGE 5 36
ECALLY YES❑NO❑ CITATION# 5A0003925 IMPROPER LANE USAGE o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- : PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YEs No ,/ D:2064992518
VEHICLE CYCLE : OWNER
16 a
LAST NAME HORROCKS FIRST NAME NICHOLAS MIDDLE q
INITIAL
17 STREET I6❑' 3715 SW 108TH ST CITY' SEATTLE ST WA ZIP 98146 37
NEW ADOREs
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YES❑No� YES❑NO❑
19[� DRIVER'S STATE WA SEX M I D.O.B. 07 18 _ 1983 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# C44747S TATE 41
WA VIN1 1GCGTDENOK1337170 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE CHEV MODEL COLORq STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NICHOLAS HORROCKS 3715SW 108TH ST SEATTLE WA 98146 D:2064992518 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 820977662IN I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF59679
COLLISION REPORT III III III III III 111
1591972 CASE# 25-546
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FARAHBAKHSH AVA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
2307 NE 4TH ST,APT J306 RENTON WA 98056 SEXi F MMDOYyry 09 - 09 - 2017
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS, 9 1 10 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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'
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.
KEITH PETTY 01-16-25 08:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 112612025 7:15:46 PM
BADGE OR ID# ( 12809 ORI# WA0171300 TIME POLICE DISPATCHED 5:18 PM TIME POLICE ARRIVED',5:27 PM
PART I PAGE IT]OF 4�
REPORT NO. EF59679 CASE# 25-546 OF COLLISION
01/16/25 17:16
OF CbLLI510N
NARRATIVE
25-546
On 01/16/2025 at approximately 1718 hours, I was dispatched to a vehicle collision with complaint of
injuries at the 200 block of S 43rd St within the City Limits of Renton, County of King, State of
Washington.
Unit 1 was Maryam Tashakkor (DOB 05/28/1978) driving her white 2023 Hyundai Sonata
(CHD5015/WA) VIN/KMHL54JJXPA056587, and a rear passenger Ava Farahbakhsh (D)B
09/09/2017) her daughter.
Unit 2 was Nicholas Andrew Horrocks (DOB 07/18/1983) driving his blue 2019 Chevrolet Colorado
(C44747S/WA) VIN/1GCGTDENOK1337170. Single occupant
Upon my arrival RRFA had already arrived and was treating the driver of unit 1 for complaint of pain
in her head and neck.
I was able to collect each involved party's information and independent summary of the events
leading up to the collision.
The driver of unit 2 stated he was heading eastbound on S 43rd St in the left turn lane approaching
Talbott Rd S. When he moved forward in the turn lane Unit 1 tried to merge into the lane behind him
and collided into the back of his pickup truck causing minor damage to his vehicle. The collision
ripped off the front bumper of unit 1 and caused fender damage and headlight damage to the front
driver's side. Unit 1 had to be towed as it was unsafe to drive away. The damage is estimated to be
over $1000.
I was unable hear from Unit 1 driver as she was taken by RRFA to valley Medical to be treated for
head and neck pain. Her daughter Ava Farahbakhsh (DOB 09/09/2017) was in her forward-facing car
seat and did not appear to be injured.
Based on the above statements, and damage to the vehicles, I determined that the Driver of Unit#1
(Maryam) is the proximate cause for the cause of collision as Maryam violated RCW 46.61.140(1)
which states that a vehicle shall be driven as nearly as practicable entirely within a single lane and
shall not be moved from such lane until the driver has first ascertained that such movement can be
made with safety. Maryam made a lane change into Unit#2's lane of travel which had the right of way
and was underway. Maryam did not ensure that traffic in lane 3 of 3 was clear of hazard before
making the unsafe lane change.
I cited via mail for Improper Lane Usage causing a collision.
Unit#1 required a tow due to extensive damage. Unit 1 made private arrangements for a tow truck. A
business card with the case number was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer K.Petty #12809 01/16/2025 @ 1846 hrs Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF59679 CASE# ' 25-546 DATE AND TIME 01/16/25 17:16
OF COLLISION
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PAGE 4 OF 4