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HomeMy WebLinkAbout24-12134 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-12134 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑ cowsloN 11 - 1-- 2024 0913 17 ❑.❑ S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ AIRPORT WAYS BLOCK NO. e✓ p 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET ❑ S ❑ W e SHATTUCKAVES 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/No D:2537780947 0 4 30 6❑ LAST NAME COC LACAN FIRST NAME MARVIN MIDDLE J 1 1 2 31 INITIAL STREET ❑, 22651 NE STATE ROUTE 3 CITY BELFAIR ST WA ZIP 98528 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ LICENSE# STATE WASEX'M MMDDYY 07 — 28 — 1989 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑ ❑P1 aT�S� D99551E sTArr WWAVIN# 5TFUY5F17CX258583 3 10 2❑ 0 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM ro rRLR. TRLR. 1 5 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 1 TOWED BY GOVT.VEHICLE 34 13 4 2012 TOYT TUNDR PK DAMAGE YES NO YES[:] No No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 912P VEH CHARGE o eorrom 5 36 LEGALLY YES No CITATION# 4g0644220 OP MOT VEH W/OUT INSURANCE 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7089667535 16 a LAST NAME GHUNAIM FIRST NAME HISHAM MIDDLE M INITIAL 17 STREET NEW ADOREs7 354 LIND AVE NW,UPPR UNIT CITY RENTON ST WA ZIP 98057 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NO INTERLOCK YEs❑NOF YEs❑NoF,/ 19 LDI IVER # STATE WA SEX DDY U M .C... 11 ❑ 25 _ 1986 El 39 HELMET I INJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ LICENSE I ❑21❑ PLA E# CKF8761 TAre 41 WA VIN# 3FA6POLU2KR179414 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' TOWED BY GOV HI 44 VEH YEAR 2019 MAKE FORD MODEL FUSIONS STYLE $D —VEHICLE TOWED NOO✓ BLIN YES NO✓ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO PROGRESSIVE 967588532IN STOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N ' 6 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 PHILIP DAVIS 12018 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF42888 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12134 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' 24-12134 On 11-23-24 around 0920hrs I dispatched to a collision at the intersection of AIRPORT WAY/SHATTUCK AVE S, Renton, King Co, WA. Initial information was vehicles, D99551 E/WA (unit 1) and CKF8761 (unit 2), were in a collision and had pulled into an adjacent parking lot. Unit numbers for identification purposes only. On arrival I observed there were no injuries and both vehicles were drivable. There was moderate damage to the front driver side of unit 2 and the front passenger side of unit 1. I contacted both involved drivers, Melvin J Coc Lacan 7-28-89 (unit 1) and Hisham M Ghunaim 11-25- 86, who advised the following. Both units were stopped at the intersection, unit 1 on Shattuck Ave S going south, and unit 2 on Airport Way going facing east preparing to go north. Both drivers advised they stopped at the intersection, which had no electricity due to recent harsh weather conditions, then proceeded into the intersection. Both drivers claimed the other was not paying attention, causing the collision. When requested, Melvin was unable to provide valid insurance and was cited for Operating a Motor Vehicle without Insurance. I provided both drivers a case number. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by P Davis 12018 on November 23, 2024 at 10:01 hours in Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. PHILIP DAVIS 11-23-24 10:35 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 1 12/6/2024 2:38:52 AM BADGE OR ID# 12018 ORI# WA0171300 TIME POLICE DISPATCHED' 9:20 AM TIME POLICE ARRIVED 9:25 AM PART I PAGE IT]OF REPORT NO. EF42888 CASE# ' 24-12134 DATE AND TIME 11/23/24 09:13 OF COLLISION i a r. PAGE 3 OF 3