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HomeMy WebLinkAbout24-11146 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 24-11146 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 02 STRUCK CONCRETE/JERSEYBARRIER 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 0014 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LOGAN AVE N BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e N 4TH ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO D:2066707011 0 11 30 6� LAST NAME ADAM FIRSTNAME MOHAMUD MIDDLE H 1 2 31 INITIAL STREET ❑ 9105 50TH S AVE APT E CITY SEATTLE ST WA ZIP 981180000 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 1/iNTERLOCKYEs NO INTERLOCKYEs Z/NO YES �No / LRIIVER # STATE WA SEXI M I EL MMDDVY 8❑ ' 12 - 10 - 1989 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ Pi aT�S� CHP0363 sTArI WAvIN# 7FARS6H56PE041009 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 5 33 12 3 0 VIN#' VIN# >; FROM TO VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 1 5 TOWED BY GOVT.VEHICLE 34 13 4 HOND CR-V UT DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER WFO MOHA..4.M910550THAVES UNITE SEATTLEWA98118 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO STATE FARM 4813791-F01.47C 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLv res❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET D:NE VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4253269698 16 a LAST NAME LEE FIRST NAME SAMUEL MIDDLE N INITIAL 17 STREET NEW ADDRESS❑' 5225 S 320TH ST CITY AUBURN ST WA ZIP 980013874 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 LICENSE# STATE WA SEX M M .C... 11 27 1989 39 20❑ ON DUTY STATUS I AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 LICENSE I ❑21❑ PLA E# CAP7385 TArE 41 WA VIN# JTHBD192X40084730 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2004 MAKE LEXS MODEL ►S34D STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS TOW YES NO REGISTERED OWNER INFO SAMUEL LEE 5225 S 320TH ST AUBURN WA 98001 VEHICLE NO.2 SHADE DAGED AREA 4 LIABILITY INSURANCE 8 POINSURGY#E CO GEIC04420-67-73-06IN 9TOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM LEGALLY YES N 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# [ZoNCY 26 KEV/N PETERSON 12808 171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. EF31333 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11146 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 10/27/24 at 0019 hours at N 4th St and Logan Ave N, in city Renton, King County WA. Unit 1 CHP0363 Driver: Adam H. Mohamud (DOB 12/10/1989) Unit 2 CAP7385 Driver: Samuel Lee (DOB 11/27/1989) Unit 2 was traveling West on N 4th St and was turning left to head South on Logan Ave N. As he went through the green light, he stated that Unit 1 hit the passenger side of his vehicle. Unit 1 was traveling South on Logan Ave N in lane 2 when he was approaching the intersection of N 4th St and Logan Ave N, he had a green light and as he went thought the intersection, he collided with Unit 2 in the intersection. Both drivers stated no injuries. Both drivers stated that they had a green light. All drivers and vehicle owners were given an information exchange with the case number. 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: 10/27/2024, 0150 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 10-27-24 04:58 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 111212024 4:10:50 PM BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 12:19 AM TIME POLICE ARRIVED';12:21 AM PART I PAGE IT]OF 3� REPORT NO. EF31333 CASE# 24-11146 DATE AND TIME 10/27/24 00:14 OF COLLISION 4j, 6 1 eA rya?`ykYZ� sw�s> G y Y Z 7, l Y;} �t a PAGE 3 OF 3