Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-11447 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-11447 z
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 1 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# ❑
cawsloN 11 - 1-- 2024 1515 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 161ST ST BLOCK NO. e✓ 12600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 40 00 FMILES EET e S ❑ E e 126TH PLACE SE
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066667715 0 11
30
6� LAST NAME DEHGHANI FIRSTNAME PARMIS MIDDLE 1 2 31
INITIAL
STREET ❑ 12627 SE 161 ST ST CITY RENTON ST WA 21p 98058 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CHW6284 sTArI WAvIN# JF2SJABC8FH423360
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2015 SUBA FOREST UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO 1.4.1)DEHGHANI 12127 SE 161ST ST RENTON WA 98058 D:4802036813 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAFECO H2535615 3 4
IN EFFECT &POLICY# 9TOP
VErIICLE 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 OWNER ❑ YES 1/ NO D:4259858955
a
LAST NAME NEWTON FIRST NAME ALESIA MIDDLE M
INITIAL
17 STREET I❑ s❑' 15775 119TH PL SE CITY' RENTON ST WA ZIP 98058 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK ves No� YEs NDF
19 LDI IVERI # STATE WA ]SEX IF M DDY
D.C.B.
11 22 _ 1964 39
20 ON DUTY STATUS AIRBAG,2 RESTR 2 EJECT 1 HE 2 INJURY 7 NATURE of INJURIES 40
USE CLASS LOWER BACK PAIN
❑ILICENSE 21❑ PLATE# 498ZGE TArE WA vIN1I YV1RS61R522173080 41
1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2002 MAKE VOLV MODEL S604D STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CURT NEWTON 15775119TH PL SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 960578051IN I U��
VEHICLE YES N
❑ C[:] CITATION# CHARGE
LEGALLY
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JAREN JOKELA 12805 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF36890
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11447
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.
JAREN JOKELA 11-05-24 05:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1111812024 3:22:21 PM
BADGE OR ID# 12805 OR]# WA0171300 TIME POLICE DISPATCHED 3:45 PM TIME POLICE ARRIVED',3:55 PM
PART I PAGE IT]OF
REPORT NO. EF36890 CASE# 24-11447 OF COLLISION
11/04/24 15:15
OF CbLLI510N
NARRATIVE
Renton Case #24-11447
On 11/04/2024 at 1545 hours I was dispatched to the 12600 block of SE 161st St, in the City of
Renton, King County, Washington. I was responding to a call of a non-injury, blocking accident. This
incident was captured on my body worn video camera. This report is a summation of events that
occurred and is not an exact sequence of events.
While en route, dispatch advised the following: Two vehicle motor vehicle accident-back pain,
declined aid, blocking unknown direction.
At approximately 1555 hours, I arrived on scene located the two involved vehicles. Both Unit 1 and
Unit 2 vehicles were located in the middle of SE 161 st St, partially blocking eastbound travel.
I identified Unit 1 as a 2015 Subaru Forester (WA LIC# CHW6284) being driven by the daughter of
the registered owner of the vehicle, identified by her WA DL as Parmis Dehghani (DOB 03/20/2008).
Unit 1 driver told me she was not injured. I asked Unit 1 driver what happened, she stated that she
was traveling westbound on SE 161 st St, approaching her residence at 12627 SE 161 st St, Renton.
Once in front of her residence, Unit 1 driver said she pulled into the opposing lane of travel, setting up
to back into the driveway of her residence. Unit 1 driver said that when she turned back into the
westbound lane of travel, she made contact with Unit 2, who was behind her vehicle and attempting
to pass in Unit 2's established lane of travel.
I observed substantial damage to the front end/front passenger side of Unit 1 vehicle as a result of
the collision.
Unit 1 driver provided me with her WADL, registration and proof of insurance.
I identified Unit 2 as a 2002 Volvo S604D (WA LIC #498ZGE) being driven by Unit 2 driver, identified
by her WA DL as Alesia m Newton (DOB 11/22/1964). No other occupants were in the vehicle of Unit
2.
Unit 2 driver said that she was traveling westbound on SE 161st St, behind Unit 1 vehicle. Unit 2
driver said that as she followed Unit 1, Unit 1 vehicle pulled into the oncoming lane, near the street
curb. Unit 2 driver said that as Unit 1 came to a momentary stop, she attempted to pass Unit 1 in her
established lane of travel -westbound on SE 161st St. Unit 2 driver said that as she passed by Unit 1,
the vehicle then sharply turned back into her lane, striking the driver side of her vehicle.
While on scene, Unit 2 driver complained of back pain as a result of the collision. Unit 2 driver
declined fire respond to the scene and stated she would get medically evaluated at a later time.
I observed substantial damage to the front left side and rear of Unit 2 vehicle as a result of the
collision.
Unit 2 driver provided me with her WADL, registration and proof of insurance.
I took photographs of both vehicles at the scene along with the sustained vehicle damage to each
unit. All photos were later uploaded to Axon Evidence. All observed damage was consistent with the
version of events provided both both Unit 1 and Unit 2 drivers.
PAGE 3 OF 5
REPORT NO. EF36890 CASE# 24-11447 OF COLLISION
11/04/24 15:15
OF CbLLI510N
NARRATIVE
I provided each involved unit with a business card, case number and answered their remaining
questions.
I then cleared the scene.
This ends my report.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. Jaren Jokela #12805, 11/04/2024 at 1851 hours in Renton, Washington.
PAGE 4 OF 5
REPORT NO. EF36890 CASE# ' 24-11447 DATE AND TIME 11/04/24 15:15
OF COLLISION
v
t
u i I
� � a
37 �
uG
#7 Jh
i
#
tt
Y5 y U
tl `
�,;� 4
c ts �
r '
7N,
r�
PAGE 5 OF 5