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Home My WebLink About25-145 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF66537OLCERA COLLISION REPORT 1591971 ❑ 0✓ FIRERES EO I CASE# 25-145 2 INTERSTATE CITY STREET FIRE STOLENSTATE ROUTE OTHER VEHICLE LOCCODIGENC'Y 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TRIBAL i UNITS TRUCK #OF 01 SO"" CONCRETE/JERSEY BARRIER 1 28 i RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s on' 01 - 05 - 2025 1405 17 =.[� S 8 W e OF IN 8 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S BLOCK NO. e 12200 E PETROVITSKY ROAD .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 22501.1 MILES FEET e✓ S 8 E e 116TH AVE SE 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 30 5 LAST NAME KAMYAB FIRST NAME ROKHANA MIDDLE t 1 2 31 INITIAL STREET ❑ 12210 SE PETROVITSKY ROAD#H2O2 CITY; RENTON ST WA ZIP; 98058 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCK YE,, NO YES NOD 8 DRIVER # STATE WA SEXI F MMDDYY' 11 - 04 - 1992 t 32 9 ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT 1 N U EET INJURY 1 NATURE of INJURIES 2 LICENSE, CDC2736 STATE WA VIN# 3FA6POH70GR330504 3 10 F1 as ATP tt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR zRLR 7 1 33 12� UIN#' VIN# : FROM TO VT,VEHICLE 13 4 VEH.YEAR 2016 MAKE FORD MODEL FUSION STYLE 40 DAMAGE TOWED NO�iS46LIN T(QiMYMEYER GO NO m 34 DAMAGE IIII._IIII I_I REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 4TOP VEn" CHARGE 5 36 Lemur YES❑NO❑ CITATION# 80TTOM 15❑ STM ING e MOTOR PEDAL-:. pROpERTY DAM THR OLD MET PHONE UNIT 02 PEDESTRIAN VEHICLE CYCLE' DOWNER YES NO 16❑ LAST NAME FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY ST ZIP ❑ 37 NEW ADDRESS 1g❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38 INTERLOCKYEs No INTERLOCK YES No vEs NQ 19 DRIVER'S # STATE SEX MMDDYY —= 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASSLICENSE ❑ 21 PLATE# TATE VIN# 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP vemae ❑ ,.I—I CITATION# CHARGE to BOTTOM EEGnEEY YES NC 25 a s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MATTHEW NUGENT 11498 WA0171300 PART A PAGE 01 OF 3000-345-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF66537 COLLISION REPORT III III III III III 111 1591972 CASE# 25-145 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES POS. ' USE GLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I 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. MATTHEW NUGENT 01-05-25 03:33 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE K.LANE 10008 1 211712025 2:08:25 PM BADGE OR ID# j 11498 ORI# WA0171300 TIME POLICE DISPATCHED 2:08 PM TIME POLICE ARRIVED i 2:09 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4 REPORT NO. EF66537 CASE# 25-145 O OF COLLI 510N TIME 01/05/25 14:05 COLLISION NARRATIVE 25-145 On 01/05/2025 at 1408 hours, I was dispatched to a single vehicle collision in the 12200 block of SE Petrovitsky Rd, within the City Limits of Renton, County of King, State of Washington. While en route, Dispatch advised that a vehicle was facing eastbound in the westbound lanes of travel. Upon arrival, I observed airbag deployment and heavy mechanism to the only involved vehicle. One of the involved parties stated that a passenger of the vehicle had already been picked up by a friend and self-transported to the hospital. Due to the mechanism, I requested the Renton Regional Fire Authority (RRFA) respond for precautionary evaluation. An independent witness remained on scene, identified via pictured WADL as Pabillon, Kenneth M (DOB 09/02/1989). Pabillon stated that he believed a younger male, described as unknown race male, 15-16 years of age, thin build, wearing black coat and black basketball shoes, was the actual driver. Pabillon stated he was driving towards the nearby apartment complex when he observed the involved vehicle traveling at a high rate of speed when it crossed into the oncoming lanes of travel and collided into a rock wall lining the north side of the roadway. Pabillon said that the younger male quickly left the scene. Based on the above statements, it is believed that Unit#1 had been traveling eastbound in the 12200 block of SE Petrovitsky Rd. Per the driver of Unit#1, she was trying to make a left turn into her apartment complex when she lost control. The driver of Unit#1 unintentionally drove off the roadway and into the rock wall. Unit#1 suffered significant damage because of the collision. Unit#1 was towed due to extensive damage. The driver of Unit#1 was provided a case number. 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 M. Nugent#11498 1/5/2025 2:34 PM Renton, King County, WA. PAGE 3 OF 4 REPORT NO. E F66537 CASE# 25-145 DATE AND TIME 01/05/25 14:05 OF COLLISION C . b�S hl ti t ;r 3 u I� It t� 14 r � z Y ` x ax PAGE 4 OF 4