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HomeMy WebLinkAbout24-12003 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-12003 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#OF OBJECT 1 ❑2$ TRIBAL UNITS 01 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION'. 11 - 1-- 2024 0257 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LIND AVE SW BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e SW 16TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES �/No D:2064835350 30 6� LAST NAME ERE FIRSTNAME ABDIRAHMAN MIDDLE H 1 1 2 31 INITIAL STREET ❑, 19334 142ND PL SE,RENTON WA, CITY RENTON ST WA 2jp, 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVERS STATE WA SEX'M MM DAY' 06 - 17 - 1999 32 CENSE 9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 LICENSE CJD0378 sTArI WAurN# 4T1G11BK2PU099080 10❑ PI ATE# TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 5 33 12❑ VIN#' VIN# FROM 34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 13 4 2023 TOYT CAMRY 4D DAMAGE YES NO �MEYERS YES❑ No✓ REGISTERED OWNER INFO ABDIRAHMAN ERE 19334 142ND PL SE,RENTON WA,RENTONWA 98058 D:2064835350 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILI INSURANCE INSURANCE CO AMERICAN FAMILY 410629286292 3 4 IN EFFECT &POLICY# 9TOP VEHCLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STAIN,DIING 7 6 UNIT 02 VEHICCLE ❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER ❑ DYES NO OLD MET PHONE 16❑ LAST NAME FIRST NAME MIDDLE INITIAL STREET CITY' ST ZIP 4❑ 37 17❑ NEW ADDRES7 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS # STATE SEX MMDDYY -❑_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ TArE 41 IN#LICENSE V 1 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO IGQVE""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 LACY SMITH 12613 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38800 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12003 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' Unit 1 was driving Southbound on Lind Ave SW when they hit several down powerlines in the intersection of SW 16TH ST/LIND AVE SW. On this night there was a windstorm that had knocked down trees and powerlines. Unit 1 hit the down powerlines that were in the roadway and damage the front of his vehicle. The driver of unit one stated he did not see the powerlines in the roadway. PSE was notified. Unit 1 was towed by Gene Myers. **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Surface Condition: FULL OF DEBRIS FROM WINDSTORM Weather: WINDSTORM **** END OF AUTO-POPULATED SECTION **** I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. LACY SMITH 11-20-24 05:23 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 1112312024 9:52:45 AM BADGE OR ID# 12613 OR]# WA0171300 TIME POLICE DISPATCHED Y:89 AM TIME POLICE ARRIVED',3:06 AM PART I PAGE IT]OF REPORT NO. EF38800 CASE# ' 24-12003 DATE AND TIME 11/20/24 02:57 OF COLLISION Lind AVE S Wl� ff i j a PAGE 3 OF 3