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HomeMy WebLinkAbout24-11864 IT ' " . 27POLCERAFFO 1 c REPORT NO EF37569 COLLISION REP FIT 1591971 CASE 24-11864 z 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 2 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 1455 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE 168TH ST BLOCK NO. e✓ 11300 4a❑ MILEPOST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 250 00 MILES FEET e S ❑ W e 0 3 29 UNIT MOTOR VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 11 30 6� LAST NAME EL-HASNAWI FIRSTNAME SALEH MIDDLE K 1 1 2 31 INITIAL STREET ❑, 13121 NE 137TH PL CITY KIRKLAND ST WA ZIP 980342303 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVERS STATE WA SEX'M MM DAY' 07 1— 27 — 1995 1 2 32 CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E C ASSS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATNES# DEALER P13446F STATE WA VIN# 4S46RBCC8D3315922 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 1. 33 12 3 0 VIN If VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 2 2013 SUBA OUTBA DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO GLEN WATABAYSHI 1.523NDAVE NE SEATTLE WA 98125 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO SHEPARD AND SHEPARD WA5427579 IN EFFECT &POLICY# 9TOP VEwcLE CHARGE 5 36 LECALLv res❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2068878255 16 a LAST NAME MCDONALD FIRST NAME OLIVER MIDDLE W INITIAL 17❑ STREET ❑', 111 3RD ST E CITY' COLUMBIA FALLS ST' MT ZIP 599120000 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 DRIVER'S STATE MT SEX M D.C.B. 05 _ 22 _ 2007 0 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CXZ055 TATe MT VIN1 JHMEJ6676VS030169 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 1997 MAKE HOND MODEL CIVIC STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44 24 DAMAGE YES NO (,ENE MEYER YES NO REGISTERED OWNER INFO JOHN MCDONALD Ill 3RD STE COLUMBIA FALLS MT599120000 D:2068878255 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU8 PORGY#E CO PROGRESSIVE 982602239IN STOP 5 VE""LE ❑ Nu,J CITATION# CHARGE LEGAL io BOTTOM LY YES 25 ' a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF37569 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11864 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' 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 11-19-24 10:34 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 1112012024 10:32:36 AM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 3:06 PM TIME POLICE ARRIVED',3:32 PM PART I PAGE IT]OF 4� REPORT NO. EF37569 CASE# 24-11864 OF COLLISION 11/15/24 14:55 OF CbLLI510N NARRATIVE blu wagon wide right slv honda/2 brakes RTF Within the city limits of Renton/King/Wa I responded to a 2 vehicle collision near the intersection of SE 168th St at 113th Ave SE. I contacted the driver of unit 2 who told me he was westbound on 168th St following unit 1. There is a broad center painted divider which is a double yellow-double yellow creating a median greater than 18" wide. Unit 2 told me he saw the brake lights on to unit 1 as unit 1 was crossing left of the double yellow-center, with no turn signal. He thought unit 1 was going left as he began to pass unit 1. However, unit 1 made a right turn towards the driveway of 11348 SE 168th St. Contact was made between both vehicles while unit 1 was making his turn. Unit 2 did not complain of injury and damages required a tow truck. I contacted the driver of unit 1 who told me that he was pulling into his driveway. He described that he needs to make the turn kind of wide. He told me he did not cross the double yellow while making this turn and wasnt sure why unit 2 made contact with is vehicle. He did not complain of injury and damages did not require a tow truck. 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 11/19/2024 PAGE 3 OF 4 REPORT NO. EF37569 CASE# ' 24-11864 DATE AND TIME 11/15/24 14:55 OF COLLISION Ott' p i � e t ue �5 n � cfa � X s� ti 4' + k§ti x t afit;t t ti s tt �tt a wo, � 4� t�t4 PAGE 4 OF 4