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HomeMy WebLinkAbout24-10972 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 SASE 24-10972 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 10 - 1-— 2024 1759 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RENTON AVE EXT BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e TAYLOR AVE NW 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO D:2068831367 0 11 30 6� LAST NAME CALLEJA FIRSTNAME TANIA MIDDLE 1 1 2 31 INITIAL STREET ❑ 654 QUEEN AVE NE CITY RENTON ST WA 2jp, 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES No�/ 8❑ DRIVERS # STATE WA SEX'F MIDI Y' 10 - 28 - 2004 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES z❑ 3 10[1Pi ATNES# CB W9492 sTAr WAV N# 4T18E30K46U135394 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 7 1 33 12 3 5 VIN#' VIN# >VI FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 34 13 4 2006 TOYT CAMRY SO DAMAGE YES Z 3 7 NO �LI I� RS vES❑ No✓ REGISTERED OWNER INFO TANIA CALLEJA 654 QUEEN AVE NE RENTON WA 98056 D:2068831367 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILIT T INSURANCE INSURANCE CO IN EFFEC POLICY# STATE FARM 509-0207.81047 & LECA LE CHARGE 5 ❑ 36 LEH'CLv res❑NO❑ CITATION# B07-fOM 15❑ STANDING MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2534026762 16 a LAST NAME GAZIT FIRST NAME AM►TAI MIDDLE INITIAL 17❑ NEW STREETREs7 10615 SE 172ND ST APT 407 CITY RENTON ST WA ZIP 98055 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE WA SEX M D.C.B. 09 _ 21 2000 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS I AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ 41 21❑ ILICENSE PLA E# A7660972 TArE WA VIN1 SALRJ2RX5M2448799 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2021 MAKE LNDR MODEL DISCOVE STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GES HI 44 24❑ DAMAGE vES�/ NO GENE MEYERS TOWING ves No�/ REGISTERED OWNER INFO AMITAI GAZIT 10615 SE 172ND ST APT 407 RENTON WA 98055 D:2534026762 VEHICLE NO.2 SHADE DAGED AREA 4 LIABILITY INSURANCE 8 POINSURGY#E CO PROGRESSIVE 00525226-0IN 1 STOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE io BOTTOM LEGALLY YES N 25 s 6 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEV/N PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF27336 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10972 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' I was dispatched to a collision on 10/21/24 at 1801 hours at the intersection of Renton Ave Ext and Taylor Ave NW, in city Renton, King County WA. Unit 1 CBW9492 Driver: Tania Calleja (DOB 10/28/2004) Unit 2 A7660972 Driver: Amitai Gazit (DOB 09/21/2000) Unit 3 CMP6490 Driver: Mohammed L. Adil (DOB 04/01/1988) Unit 1 was traveling East on Renton Ave Ext and was going to turn North onto Taylor Ave NW. When unit 1 went to turn thinking she had enough space she stated that vehicle 2 which was traveling West bound on Renton Ave Ext approached to fast and hitting her before she cleared the intersection. Unit 1 stated it all happen so fast. Unit 2 told me he was traveling in lane 1 heading West bound on Renton Ave Ext and at the intersection and that the driver of unit 1 was crazy. Unit 2 stated he was going up the hill at the intersection before the crash. Unit 3 told me he was sitting at the intersection light on Taylor Ave NW facing South when Unit 1 went to turn left, and Unit 2 hit her which then pushed her into his front end of his stopped vehicle. Unit 3 stated he was just sitting at the light, and it all happen so fast. All drivers involved were seen on scene by fire, No injury's reported. All drivers had the account of what happen. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 10/21/2024, 2344 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 10-21-24 11:47 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 1012212024 2:17:55 PM BADGE OR ID# ! 9Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 6:01 PM TIME POLICE ARRIVED 6:04 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EF27336 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-10972 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE _) PEDESTRIAN � OWNER � YES NO D:2063769956 rFO 8 29 LAST NAME ADIL FIRST NAME MOHAMMED MIDDLE' ',, L INITIAL STREET 30 NEW AnDRFrtP 315 STEVENS AVE NW CITY RENTON ST WA ZIP 98057 6 [2 1 1 2 31 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED INTERLOCK YEs NO INTERLOCK YES❑N0� YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 04 TO]- 1988 7 ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE CMP6490 TAr WA VIN# JHLRE48548CO44435 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1I' E FROM TO 2008 HOND CRV UT DAMAGE YES NO YES NO REGISTERED OWNER INFOMOHAMMED ADIL 315 STEVENS AVE NW RENTON WA 98057 D:2063769956 J 9 33 12 � SHADE IN DAMAGED AREA 4 FROM TO LIABILITY INSURANCE INSURANCE CO GEICO 6171.787.341 q"i"Olx IN EFFECT &POLICY# VEHICLE 10 6QTTUM 34 13 ❑ LEGALLY YES NO❑ CITATION# CHARGE gg�@ STANDING S} l:9 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME NIITIA 36 L ❑ STREET"[—] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAT VIN# 39 PLATE# 20 ❑ TRAILER TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 a 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P _ 4 E:l 44 24 LERICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 10-21-24 11:47 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12808 O#I',WA0171300 SUMMERS 10122/202 PAGE 3 OF 4 3000-345-013 IR 11t18) REPORT NO. EF27336 CASE# ' 24-10972 DATE AND TIME 10/21/24 17:59 OF COLLISION AWN*A 4 2. 0+ Yn it}t ti tl� S 4 r � C 4 HIV I�yal r�9 � i9 u lil br +�w PAGE 4 OF 4