HomeMy WebLinkAbout25-1023 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-1023 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F E: LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
5
RESERVATION 1
TRIBAL UNITS 03 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# 0 9
CowsloN 02 - 01 - 2025 0838 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4615
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533943665 2 01
30
6� LAST NAME EDGINGTON FIRSTNAME RACHEL MIDDLE E 1 1 2 31
INITIAL
STREET ❑✓ 818 S 3RD ST CITY RENTON ST WA 21p 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEXI F MM DAY' 02 1— 08 — 1982 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 ATE 14 150XXE STATE WA u N# JA3AU86WX90007531
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 3 34
13 4 2009 MITS LANCER SD DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PATRIOT GI INS 11408486393 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064577853
16 a
LAST NAME FOFANA FIRST NAME MUSA MIDDLE I L
INITIAL
17❑ STREET ❑', 4207 MARTIN LUTHER KING JR WA CITY' SEATTLE ST WA ZIP 981081683 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YYEEsI I I NoF YES t l NO❑
19 D IVEW # STATE WA SEX M MMDDW O6 _ 11 2006 0 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CKG5114 TATe WA VINIi 19XF62F57EE258596
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
GI
VEH YEAR 2014 MAKE HOND MODEL CIVIC STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2025178431 1 STOP
IN EFFECT
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG i o BOTTOM
ALLY YES
25 '
=Kl
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF61708
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1023
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KASSIM SALAH
(IAST FIRST,
ADDRESS&PHONE#
2066474004 SEX' M MMDDYYYY 11 - 25 - 2007
PASSENGER WITNESS UNIT# 2 SEAT 3 AIRBAG 2 RESTR. 1 EJECT ? 1 HELMET INJURY11
NATURE OF INJURIES
L`!1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On Saturday, February 1, 2025 at 0841 hours, I was dispatched to a motor vehicle collision in the
area of the 4600 block of NE 4th St.
The following occurred within the City of Renton, King County; Unit 1 - WA/ 150XXE was being
driven by Rachel Edgington and was traveling west in the #2 lane left of NE 4th St in the 4600 block.
Unit 2 - WA/ CKG5114 was driven by Musa Fofana and was traveling west in the #2 lane on NE 4th
St in the 4600 block. Unit 3 -WA/ BGL7229 was driven by Vimal Selvam and was stopped at the
intersection of NE 4th St and Duvall Ave NE in the left turn lane.
I spoke with Rachel who stated she was driving straight and the vehicle (Unit 2) in front her abruptly
braked and attempted to change lanes, when she was unable to stop and collided with the rear
bumper of Unit 2 causing significant damage to both vehicles. After Unit 2 was struck it continued
straight on NE 4th St and collided with the passenger side door and fender of Unit 3 cause significant
damage to both vehicles.
I spoke with Musa who stated he was driving straight on NE 4th and was struck from behind and the
force of the collision caused his vehicle to collide with Unit 3.
1 spoke to Vimal who stated he was in the left turn lane and noticed a vehicle driving erratically and
attempting to get behind him when that vehicle was struck from behind and continued into the
passenger side of his vehicle causing significant damage.
Based on all statements it appeared that Unit 2 failed to slow properly and signal in enough time to
allow Unit 1 time to slow which contributed to the collision. Based on the fact of the descriptions of
effects are feasible, without any evidence to prove one way or another, I am unable to determine
proximate cause of the collision.
All vehicles sustained significant damage but only Unit 1 needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 02-01-25 10:12 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 2/2/2025 1:57:23 PM
BADGE OR ID# 12598 OR]# WA0171300 TIME POLICE DISPATCHED 8:41 AM TIME POLICE ARRIVED 8:45 AM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. EF61708
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 25-1023
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J CYCLE _) PEDESTRIAN � OWNER � YES� NO
D:4256174004
0 4 29
LAST NAME :. SELVAM FIRST NAME VIMAL MIDDLE'.. ,.. K
INITIAL r:j
STREET 30
NEW AnDRFrtP 260 BREMERTON AVE NE CITY RENTON ST WA ZIP 98059
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:]
YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 07 - 12 - 1982
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BGL7229 [TAT WA VIN# 1HGCR2F75EA050673
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 3 5 VEH.YEAR2014 MAKE HOND MODELACCORD STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER ] 1 33
12 � SHADE IN DAMAGED AREA
4 FROM TO
LIABILITY INSURANCE❑ INSURANCE CO TRAVELLERS 616441580
IN EFFECT &POLICY# 5 4 TCSP S.
vEHICLE 10 60T1Y)M 34
13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE
STANDING } 8 7 6
14 ❑ UNIT Tr Vd 1 RE O CYCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
El PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
STREET"[-]
16 NEW nnR CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE ICLASS
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
ViN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LecALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J,WISNIEWSKI 02-01-25 10:12 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OBADGE R ID# 12598 O#II,WA0171300 APPROVED BY
2/2/2025 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. EF61708 CASE# 25-1023 DATE AND TIME 02/01/25 08:38
OF COLLISION
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PAGE 4 OF 4