HomeMy WebLinkAbout25-3163 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF81579oc� RA
COLLISION REPORT 1591971
ASE# ; 25-3163 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOL`CO A`GENC'Y 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SOBJECT 7RUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
CDLL.ISION'. 04 - 08 - 2025 1303 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e 800 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�. FEET S 8 W e S GRADYWAY
2 0 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:9196207189 Q 1 30
6 LAST NAME AHMAD FIRST NAME KAREEM MIDDLE M 1 2 31
INITIAL
STREET ❑ 420 W SMITH ST APT 510 CITY KENT ST WA ZIP 980324441 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No INTERLOCKYEs NO vEs NO
8 LICIENS# STATE WA SEX'M MMor YY' 09 - 30 - 1990 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CDL4900 STATE WA VN# 2HGES16563H616604 3
10 PI ATF#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
rRLR LR 1 5 33
1 3
FROM TO
2 P5 VIN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 3 2003 HOND CIVIC DAMAGE YES DNo ✓ vEs❑ No 1 5 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE f NSURANCE CO PROGRESSIVE 975450344
IN EFFECT &POLICY# 9TOP _
YEs
IALLNG NO CITATION#❑ 5A0407877 CHARGE INATTENTIVE DRIVING B o eoTrob 36
15 STM
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' ❑ ❑ nWNFR vEs No �/ D:2065731153
16�
LAST NAME BOZHKO FIRST NAME JACOB MIDDLE' Y
INITIAL
STREET ❑ 37
17 ❑ 35710 51 ST AVE S CITY AUBURN ST, WA ZIP 980019108 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTEDi 38
INTERLOCKYEs No INTERLOCKYES 0No vEs No
19 DRIVER'S STATE WA SEX M E.O.B. 01 17 2007 39
LICENSE# MMEDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES � 40
SS
21[ LICENSE
LATE# C98177Y rarE WA vIN# 1FTEX1EP3HFB67300 41
22❑ PLATE# STATE PAAILER
TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q17 MAKE FORD MODEL F150 STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO YURIBOZ 1111011STAVES AUBURNWA98001 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO AMERICAN FAMILY INSURANCE CA00017412
IN EFFECT &POLICY# I R
vemcteLe ❑ N.I—I CITATION# CHARGEtO.LJ25
cntLr YES
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF81579
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3163
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.ARNOLD 04-08-25 02:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/11/2025 6:53:55 AM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 1:08 Pry TIME POLICE ARRIVED 1:12 Pm
PART B 3oDo-345-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EF81579 CASE# 25-3163 O COLLI COLLISION TIME
OF 04/08/25 13:03
COLLI
NARRATIVE
CC 25-3163
On 4/8/2025 at 1306 hours I was dispatched to a motor vehicle collision that occurred at the
intersection of Rainier Ave S and S Grady Way in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was in the #2 lane traveling South on Rainier Ave S preparing to go straight
through the intersection of S Grady Way onto SR 167 SB.
Driver 1 stated that he was traveling South of Rainier Ave S approaching S Grady Way in the #3 lane
preparing to merge right into the #2 lane.
Collision
Driver 2 stated that once at the intersection, Unit 1 merged from the #3 lane into the #2 lane where he
was at. Driver 2 stated that the front passenger side mirror and front passenger side door collided
with the front drivers side bumper of Unit 2.
Driver 1 stated that he did not see Unit 2 and merged from the #3 lane into the #2 lane where Unit 2
was at. Driver 1 stated that the front driver side bumper of Unit 2 made contact with the passenger
side mirror of Unit 1, then scraped along the front passenger door, and then caused a substantial
dent in the rear passenger door.
Injuries
Neither driver complained of injuries.
Vehicle Disposition
Both vehicles remained operable and were driven from the scene.
Proximate Cause
I determined that Driver 1 is at proximate cause for this collision because he operated a vehicle upon
a public roadway within the City of Renton in an inattentive manner due to a lack of alertness for the
presence of traffic. If Driver 1 had been alert to the presence of traffic, this collision would not have
happened.
I certify (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. Arnold #12509 at 13:56 on 4/8/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF81579 CASE# 25-3163 DATE AND TIME i 04/08/25 13:03
OF COLLISION
t�
?r
k
2
1
l
1 k L y
c
4
w
G
PAGE 4 OF 4