HomeMy WebLinkAbout24-9999 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF37566 170
27
COLLISION REP FIT 1591971
SASE 24-9999 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION' 09 - 1-- 2024 0718 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK NO. e✓ 1100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MAIN AVE S
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069810103 0 3 30
6� LAST NAME NESSAR FIRSTNAME RAMIN MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 12210 SE PETROVITSKY RD APT K CITy RENTON ST WA Zjp, 980586653 z
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 ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CLE1570 sTATI WAvIN# 5TDZA23C94S111087
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# ROM To
TRLR. TRLR 5 3 33
12 0 0 VIN#' VIN#
>;. FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 1 2004 TOYT SIENNA VN DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO RAMIN NESSAR 12210 SE PETROVITSKY RD APT K RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 983195322 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067717861
16 a
LAST NAME BRIGGS FIRST NAME JESSICA MIDDLE M
INITIAL
17 STREET I❑ s❑' 13433 48TH AVE S CITY' TUKWILA ST WA ZIP 981683233 4❑ 37
NEW ADDREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK v�Esl I I NOF YES t l NO❑
19 D IVEW # STATE WA ]SEX IF M D.C.B. 08 _ 22 _ 1962 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE ❑21❑ PLA E# CBM9436 TATE WA VIN# 41
19XF62F86EE029840 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2014 MAKE HOND MODEL CIVIC STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JESSICA BRIGGS 1353352ND AVE S APT 2 TUKWILAWA98168 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 5409726F1747CIN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF37566
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9999
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'
On 9-24-24 at about 0720 1 came upon what I believed was a blocking disabled at the intersection of
S 3rd street and Main Ave S. When I contacted the driver (later identified as driver 2, Jessica Briggs)
she told me;
She was turning from Main Ave S when unit 1 crossed into her lane and collided with passenger's
side of her vehicle.
She was not injured.
Unit 1 was sitting at the corner of S 3rd and Main Ave S. I spoke to the driver later identified via
WADL as Ramin Nessar. I got Nessar to drive around the block and meet us in the parking lot of 200
Mill Ave S. Nessar took ownership of being the causing party for the collision. I facilitated the
exchange of information and released both parties.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 10-22-24 09:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 11/20/2024 10:41:59 AM
BADGE OR ID# 1953 OR]# WA0171300 TIME POLICE DISPATCHED; 7i20 AM TIME POLICE ARRIVED 7:20 AM
PART I PAGE IT]OF 3�
REPORT NO. EF37566 CASE# 24-9999 DATE AND TIME 09/24/24 07:18
OF COLLISION
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