HomeMy WebLinkAbout25-744 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67177oc� RA
COLLISION REPORT 1591971
❑ 0✓ RESULTED I
CASE 25-744 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCALAGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E E IN
eDL�ISION' 01 - 23 - 2025 1610 17 =.�� S W OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e 700 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 120 00 FEET e✓ S 8 W e SW GRADY WAY
2 0 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2067171158 0 1 30
5 LAST NAME TAWFIQ FIRST NAME ALI MIDDLE B 1 1 2 31
INITIAL
STREET ❑ 4635 S 255TH ST APT G206 CITY; KENT ST WA ZIP; 980324703 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDIQAL TRANSPORTED 3
INTERLOCKYES No INTERLOCKVEs NO YES NO
8 DCIENSE# STATE WA SEXI M MMDDYY' O6 — 28 — 1994 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 NATURE of INJURIES 2
LICENSE, CLG8955 STATE WA VIN#; 4T1BB46K87U019557 3
10 Fl I as ATP rt
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR TRLR 1 5 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2007 MAKE TQYT MODEL CAMRY STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 $ 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO ALITAWFIQ4635S255THSTAPTG206 KENTWA980324703 D:20 6 71 711 5 8 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 3 4
2 LIABILITY INSURANCE INSURANCE CO
14 Z FOREMOST G01 4912598 01
IN EFFECT &POLICY# Q�Q
CHARGE36
VEHICLEyes❑NO❑ CITATION#15 sTnNowc
MOTCSR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO �/ D:2068227456
16�
LAST NAME BUDUL FIRST NAME ELHAM MIDDLE A
INITIAL
17 STREET ❑ 11025 17TH AVE SW CITY SEATTLE ST, WA ZIP 37
981462025
NEW ADDRESS ❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED' 38
INTERLOCKYES NO INTERLOCK YES NOR
19 DRIVERS STATE WA SEX,F I D.a.B. 12 08 2003 � 39
LICENSE# MMDRYY -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE CMP8591 TATE WA VIN# 5FNYG1H73SB015683 I El 41
22❑ [TILER TAILER PLATE# STATE PLATE# STATE 0 42
23= TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 202$ MAKE HOND MODEL PILOT STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MUNA HAGI 1102517TH AVE SW SEATTLE WA 98146 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
HICLE,EILe L YES❑ NJ—I, CITATION11 CHARGE to BOTTOM
VE
25 a F
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF67177
COLLISION REPORT III III III III III 111
1591972 CASE# 25-744
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 0,SS ----�
: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.
M.LEVERTON 01-24-25 07:27 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 211912025 1:40:26 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:11 Pry] TIME POLICE ARRIVED i 4:13 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF67177 CASE# 25-744 O OF COLLI 510N TIME 01/23/25 16:10
COLLISION
NARRATIVE
blu/2 lane 1 red/1 left In cgn to lane 1 forced
RTF
Within the city limits of Renton/King/Wa I respond to a 2 vehicle blocking crash at the 700 block of
Rainier Ave S.
Both vehicles were able to be driven clear of the roadway.
I contacted the driver of unit 1 who told me that he was signalling his lane change while traffic was
stopped. Moved his vehicle from the southbound right turn only lane into lane 1 and blocked both
lanes. He said when the light turned green unit 2 accelerated and hit him on purpose and was going
way too fast. He did not complain of injury and damages was minor and did not require a tow truck.
I contacted the driver of unit 2 who told me she was stopped in traffic lane one on a red light. When
the light turned green she began to proceed along with traffic. She told me at the last minute unit 1
basically forced his way into her lane and contacted her vehicle. She did not complain of injury and
damages was minor and did not require a tow truck.
Unit 1 said there is a requirement that each vehicle stopped be a certain distance from the next, and
that his signal requires another vehicle to yield. He went round and round about certain requirements
applied to unit 2 but not to him. Even explaining the RCW's reference many of his allegations he
denied responsibility or contribution to the crash.
Information/insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 1/24/2025
PAGE 3 OF 4
REPORT NO. E F67177 CASE# 25-744 DATE AND TIME 01/23/25 16:10
OF COLLISION> '
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