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HomeMy WebLinkAbout24-11327 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c COLLISION REP FIT 1591971 CASE 24-11327 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 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# GawsloN 10 - 1-- 2024 1458 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S GRADY WAY BLOCK NO. e✓ ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e RAINIER AVE S 2 0 29 UNIT MOTOR Z CYCLE ES ❑ YESAGE NHORE✓LD MET PHONE 0 1 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STATE I SEX u MMDDYY '❑- 1 1 2 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 LICENSE sTATI urN#' 10[ PI ATE# TRAILER STATE STATE STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 3 5 vIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 2 DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO [NEW] VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICV# 9TOP vewcLE CHARGE 5 36 LECALLv YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 6 UNIT 02 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE ❑VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2532055780 16 a LAST NAME MOHAMUD FIRST NAME NASRA MIDDLE A INITIAL 17 STREET I❑ 2835 S 148TH ST CITY SEATAC ST WA ZIP 981684245 37 NEW ADOREss❑' 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑ 19 LDI IVEW # STATE WA ]SEX IF M .C.B. 01 01 1988 El 39 HELMET I {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ LICENSE ❑21❑ PLA E# 9EAM824 TATE 41 CA vIN# 4T1G11AK3PU770404 4 42 22 [TRAILER TILER ❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2023 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO EAN HOLDINGS LLC 14002 E 21ST ST STE 1500 TULSAOK74134 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO AMERICAN FAMILY.IN I STOP 5 VE""LE ❑ N`L J ,J� CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF31933 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11327 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 PM 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' 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. M.LEVERTON 10-31-24 03:50 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 111412024 1:52:41 PM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 2:89 Pry TIME POLICE ARRIVED]3:11 PM PART I PAGE IT]OF 4� TIME REPORT NO. EF31933 CASE# 24-11327 OF COLLISION10/31/24 14:58 NARRATIVE BLK SUV/1 LANE CHANGE PASS WHT SEDAN/2 LANE 1 RTF Within the city limits of Renton/King/Wa I responded to a 2 vehicle hit and run about the 100 block of S Grady Way. I contacted the driver of unit 2 in a nearby parking lot. She told me she had turned from NB SR167/Rainier Ave S onto S Grady Way and was in lane 1. She said unit 1 was behind her and changed from lane 1 into lane 2 and while unit 1 was making this lane change drove into the back driver side of her vehicle, causing damage. She said after unit 1 hit her car they fled across the intersection of Lake Ave S and went back west bound on S Grady Way making an obvious attempt to flee rather than remain on scene of the crash location. Unit 2 did not complain of injury and damages did not require a tow truck. She told me she could only say it was a large black SUV, but did not provide any additional information ref the driver or license plate, year make or model. Information/Insurance only I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. M.Leverton/2517 City of Renton/King/Wa 10/31/2024 PAGE 3 OF 4 REPORT NO. EF31933 CASE# ' 24-11327 DATE AND TIME 10/31/24 14:58 OF COLLISION ."y �414�y1 t Y t 1 h 7 'y tj cu` � t PAGE 4 OF 4