HomeMy WebLinkAbout24-12518 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 24-12518 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 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#
COLLISION'. 12 - 1-- 2024 1236 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:2534573773 0 4 30
6� LAST NAME DIALLO FIRSTNAME BOUBACAR MIDDLE N 1 2 31
INITIAL
STREET ❑ 13130 SE 210TH ST CITY KENT ST WA 2jp, 980312203 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10[1 PI ATNE 14 C13170X sTAr WAuN# 1FTNE24t33HA83307
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. A'RLR. 1 3 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 3 34
13 2 2003 FORD ECONO DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO JOSHUA FONJAH 2113 S 252ND ST DES MOINES WA 98198 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6183-55.94.72 3 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4254441169
16 2
LAST NAME REIDEL FIRST NAME CHRISTINA MIDDLE I/
INITIAL
17❑ STREET ❑', 5320 E MASON LAKE DR IN CITY C�RAPEVIEW ST WA ZIP 985469567 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 LICENSE# STATE WA SEX F M D.C.B.
O6 _ 11 1969 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CFF5086 TAre WA vIN1i 7SAYGDEE9NF571444
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GoI
VEH —VEHICLE
YEAR 2022 MAKE TESL MODEL MODE!Y STYLE UT AMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSURANCE
#E CO USAA 0037114046
IN IUR'E""LE
❑ ,J� CITATION# CHARGELEGALLYYES N
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF44830
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12518
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.
C.CATALAN 12-05-24 01:52 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1211112024 2:36:46 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; ?Y:39 PM TIME POLICE ARRIVED',12:46 PM
PART I PAGE IT]OF 4�
REPORT NO. EF44830 CASE# 24-12518 OF COLLISION
12/05/24 12:36
OF CbLLI510N
NARRATIVE
On December 5, 2024, at approximately 1236 hours, I was dispatched to an unknown-if-injury vehicle
collision at the intersection of NE 4th Street and Duvall Ave NE, within the City Limits of Renton,
County of King, State of Washington.
Upon my arrival, 1 confirmed there were no complaints of injury requiring immediate medical response
at the time of report. There, I was able to collect each involved party's information and independent
summary of the events leading up to the collision.
The driver of Unit 1 said he was making a left turn from Duvall Ave NE to NE 4th St. They were in the
number 1 left turn lane. The driver of Unit 1 stated that while making their left turn, Unit 2 was in the
number 2 left turn lane. As they turned, they collided in the middle of the intersection. The driver of
unit 1 stated that unit 2 failed to maintain their lane and drove into his passenger side front fender.
This caused minor damage.
The driver of Unit 2 said she was the sole occupant of his vehicle and was also making a left turn
from Duvall Ave NE to NE 4th St. Unit 2 was in the number 2 left turn lane. Unit 1 drove beside her in
the number 1 left turn lane. As they proceeded to make their left turn, unit 1 failed to maintain their
lane and drove into her driver's side mirror and door, causing moderate damage.
Based on the above statements, 1 was unable to determine who committed the traffic violation.
This is an information report only and an exchange of information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Catalan 12/05/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF44830 CASE# ' 24-12518 DATE AND TIME 12/05/24 12:36
OF COLLISION
i V
a
f f
n\�i4x4
i
d
tf unzei
r
\s'
sF
t�i V rr 2
au( 1
On�
n
ti
Y� I
§ �. S'Y 5• 'I 4 ��r�YI Y 4��1 I vri�t�s'Y� y t
PAGE 4 OF 4