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TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 2 27c . ,one COLLISION REP F 1591971 CASE 24-10435 2 INTERSTATE CITY STREET FIRE ❑ RESULTED STOLEN 1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4100 3[� HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TRIBAL N 75 TOTAL#OF STRUCK OBJECT 11 7 28 RESERVATION 2 3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY# LOLL s ON 10 - 06 - 1 0900 17 �. e W 8 OF IN 8 1070 3 S 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 19TH CT BLOCK NO. 8✓ 4903 .� 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 MILE eFEET ✓ S e W 8 FIElD AVE NE 1 5 29 MOTOR PEDAL- DAM ETHRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES No F,/ D:4256528300 2 2 30 5� LAST NAME : $IGESMUND FIRST NAME JAIMIE MIDDLE' B 1 2 31 INITIAL STREET E:1' 4903 NE 19TH CT CITY RENTON WA NEW ADDRESS Sr ZIP 98059 z 7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES Noy/ INTERLOCKYEs NOW YES NO,/ LICENSE# STATE WA SEX'F MMDDW 02 - 06 - 1985 32 9 F] ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES 2 10❑ LICnNS#, CMA6957 STATE WA WIN#' 1C4RJKBGXR8922056 3� 11 0 0 PLATE# STATE TRAIPLATE# STATE ROM To RA TRLR TRLR. 7 O 33 12 O 0 vIN#' VIN# FROM TO 13 9 VEH.YEAR 2024 MAKE JEEP MODEL GRAND STYLE VEHICLETOWEEDFt1 T02fBLIN TOWED BY GODAMAGVT,VENOCL✓ m34 ❑ REGISTERED OWNER INFO JAIMIE SIGESMUND 4903 NE 19TH CT RENTON WA 98059 D:4256528300 IL—llll VEHICiL.E cc NO. 'II 1 SHADE 1N DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE� INSURANCE CO NATIONWIDE 7246J058688 IN EFFECT &POLICY# i 4TOP VEHICLE CHARGE ❑ 36 EGALI v YES[:]NO[:] CITATION# 10 BOTTOM 15❑ sTAnomc a i 6 MOTCJR PEDAL PROPERTY DAM THR OLD MET PHONE UNIT ❑ PEDESTRIAN VEHICLE CYCLE OWNER YES NO 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL. 17 STREET 37 CITY TUALATIN ST ZIP 4 ❑ SS NEW ADDRESS : 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 WTERLOCKYEs ND INTERLOCKYEs NO✓ YES NI 19 LIICENSE# S1A7E SEX U MMDDYY 39 20 ON DUTY STATUS AIRBAG g RESTR g EJECT 1 H UE7 9 �SE � 0 NATURE OF INJURIES 40 ASS 21❑ LICENSE 440PVH 41 PLATE# rATe OR viN# 42 22 PLATE#TRAILER STATE PLATE TRAILER STATE 23 TRLR 43 RLR VIN# IN# VEH.YEAR 2024 MAKE HOND MODEL ACCORD STYLE $D DAMIAGE TOWED NOO✓ BLIN TOWED BY YES N GO HI 44 YES O 24 REGISTERED OWNER INFO EAN HOLDINGS LLC 20400 SW 7ETON AVE TUALATIN OR 97062 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYA104450567 IN EFFECT &POLICY# t 4TOP 5 VEHICLE ❑ U CITATION# CHARGE tOBOTTQM LEGALLY YES N 25 B 71FFIIER�S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 l!lIPS 11649 WA0171300 PARTA 9000-345-159. (R 11(181 PAGE 01 OF STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF22175 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10435 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) SIGESMUND CAMERON B ADDRESS&PHONE 4903 NE 19TH CT RENTON WA 98059 4256528300 SEXi (y� MD B. 11 - 24 - 2021 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ 1 POS. 9 2 10 1 USE 2 ':CLASS 1 � ----� :NAME (LAST FIFS7 MIDDLE INITIAL} ADDRESS&PHONE# SEX D.O.B. - MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NA7UREOFINJURIES POS. USE CLASS ----� :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 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. R.PHILLIPS 10-06-24 04:51 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE DESIREE SCOTT 10272 10/7/2024 11:33:45 AM BADGE OR ID# 11649 ORI# WA0171300 TIME POLICE DISPATCHED; 9:04 AM TIME POLICE ARRIVED i 9:10 AM PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F5 TIM REPORT NO. EF22175 CASE# 24-10435 OF COLLI ION 10/06/24 09:00 OF COLLISION NARRATIVE On 10-06-2024 at 0904 hours I was dispatched to a two-vehicle injury collision at 4903 NE 19th CT in the city of Renton, King County WA. I arrived on scene and observed a black SUV parked partially in a driveway and a black sedan parked behind it. I spoke with the driver of the SUV, Jaimie Sigesmund who told me the following: Sigesmund lives at the 19th CT address. Her husband just left the residence and she was getting ready to leave as well. She opened the garage door and backed up. She looked back but didn't see the black sedan parked perpendicular to her driveway in the street. She heard and felt the two vehicles collide and stated she was going 5-7 MPH as she backed up. She exited her car and saw unit 2 behind her and a male sitting in the back seat. Sigesmund's two year old son was in the back seat of the car in his car seat. He was not injured. I spoke with the driver of unit 2 Shafi Abdulahi who told me the following: Abdulahi was delivering packages and was standing in the door opening at the rear driver's side. The door was open. Abdulahi didn't see unit 1 coming and was struck from behind. He said he was in a lot of pain, 8/10 and needed medical. He told me the door closed on him and the car struck him in the back. Abdulahi did appear in pain but seemed to be twisting and moving a lot in the back seat of the car. Renton Fire arrived and transported Abdulahi my Tri-Med to Valley Medical Center for care. Abdulahi's car had a scuff mark and paint transfer on the end of the door on the inside. Unit 1 had paint transfer on the outside of the vehicle indicating the door of unit 2 was opened and slid down the side of unit 1 and didn't close on Abdulahi. checked the area for cameras. The residence to the east had cameras but they didn't work. The residence on the west had a camera that turned on when I walked up but the owner wasn't home. Neither car needed towed. Abdulahi's car was left on scene at his request. Both sides were given the case number. I took photos of the scene. It appears the collision was caused by Sigesmund not looking behind her and backing into unit 2. Both drivers were identified by their WA driver's license photos. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. This report was electronically signed by Officer R. PHILLIPS #11649, October 6th, 2024 Renton, WA. PAGE 3 OF 5 4( � SUPPLEMENTAL REPORT NO. EF221755 1 $ 27 }_ POLICE TRAFFIC COLLISION REPORT CASE#+ 24-10435 1 COMMERCIAL MOTOR CARRIERT INTERSTATE INTRASTATE L UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER 7 ADDRESS CITY ST ZIP 4 NAME # PLACARD GWVR ❑ NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS t MOTOR E] PEDAL- (``� PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ 11 N IT 3 VEHICLE I_I : CYCLE L_J PEDESTRIAN Z OWNER '.� YES NO D:6142544832 29 LAST NAME ABDULAHI FIRST NAME : SHAR MIDDLE M INITIAL STREET 30 NEW AnnRFARE] 4220 S 164TH ST UNIT 3C CITY TUKWILA ST WA ZIP 98188 6 PRESENT MEDICALTANSPORTED 1 31 CDL IGNITION RE IGNITION INTERLOCK YES: NO '.INTERLOCK YES Nb YES[:]N 2 DRIVER'S LICENSE STATE SEX M MMD DYYY 02 - 03 - 2000 :. HELMET INJURY NATURE OF INJURIES 7 ON DUTY STATUS 3 AIRBAG RESTR. EJECT USE 2 CLASS 6 BACKPAW 8 ❑ 1 32 LICENSEE TAT UtN PLATE# 2 9 9 TRAILER TRAILER PLATE# STATE PLATE#k :STATE 10 ❑ TRLR TRLR VIN..#. VIN.#. 11 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWE E T ABLIN TOWED BY GOI VFHIC!F FROM TO DAMAGE YES NO YESLl NO Ll REGISTERED OWNER INFO. 7 3 33 12 SHADE DAMAGED AREA LIABILITY INSURANCE❑ 4 FROM TO INSURANCE CO 9,FC1P IN EFFECT &POLICY# 13 ewcLe YES NO CITATION# CHARGE 1CkBOTTC)M m 34 GALI Y sTnNolNc R T 6 14 ❑ UNIT' MOTOR Ell PEDAL- PEDESTRIAN � PROPERTY ❑ DAMAGETHRESHOLD MET PHONE El 35 VEHICLE CYCLE OWNER YES NO 15 LAST NAME FIR87NAME MIDDLE INITIAL TIAL ❑ ❑ STREET 16 NEW annREG�' CITY ST ZIP'. CDL IGNITION RFOUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YES N INTERLOCK YES NO YE3 NO 17 4 37 DRIVER'S STATE I SEX D.O.B 18 ❑ LICENSE# MMDDYYY ON DUTY STATUS' USE CLASS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIEs ❑ 38 19 LICENSE. TA VIN# � 39 PLATE# 20 TRAILER TRAILER Ll 40 PLATE# STATE PLATE# STATE 21 ❑ 41 TRLR TRLR VIN#i U[N#; 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23F; 2 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 LIABILITY INSURANCE INSURANCE CO 2 3 4 IN EFFECT � &POLICY# 1 _4 TOF' 44 24 YES[:] verncLe NO❑ CITATION# CHARGE 70 k3C1TT061 LEcnuy srnNOlNc S 7 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT, R.PHILLIPS 10-06-24 04:51 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED [-� BADGE I APPROVED P Y 0 /202 26 ORID# 11649 WA0171300 SCOTT PAGE F4 OF 3000-345-013(R 11/181 REPORT NO. EF22175 CASE# 24-10435 DATE AND TIME 10/06/2409:00 OF COLLISION �t5 1 y t i; t a rota+ � t Y t � 1 n d ti d t'1 xt, � � r � t PAGE 5 OF 5