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Home My WebLink About25-3683 �oLcRaiTFFiN 5 3 27c REPORT NO. EF89256 "i ,one COLLISION REP F 1591971 CASE# 25-3683 2 INTERSTATE CITY STREET FIRE ❑ RESULTED STOLEN 1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4100 3[� HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TRIBAL TOTAL UN 7S#OF OBJECT 1 STRUCK 1 8 28 03 STREET LIGHT POLE RESERVATION 2 3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY# COAT sloN 04 - 25 - 1 1320 17 �. e W 8 OF IN 8 1070 3 S 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NE SUNSET BLVD 8✓ .� 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1.= FEET e S e W B HOQUIUM AVE NE 0 1 29 MOTOR PEDAL- DAM ETHRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES ,/NoF D:4252040684 0 4 30 6 LAST NAME CARLSON FIRST NAME JAMES MIDDLE' F 1 2 31 INITIAL STREET E:1' 10334 151 ST AVE SE RENTON WA NEW ADDRESS S7 ZIP 980595720 z C17y 7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs No INTERLOCKYEs NO171 vEs Na 8❑ LICENSE STATE OVA SEX'M MMO B 11 - 22 - 1925 1 2 32 1 I INJURY NATURE OF INJURIES 9 ON DUTY STATUE AIRBAG 1 REST 4 EJECT 1 HELMET CLASS 7 BEING CHECKED 2 PI LICENSE 992YEM STATE WA WIN# 2FABP74F9KX131370 10 1❑ 3 11 3 5 PLATE# STATE PLATE#I TRAILER STATE FROM TO TRAILER TRLR TRLR. 3 7 33 12 3 0 VIN#' uIN# FROM TO 13 2 VEH.YEAR1989 MAKE FORD MODEL CROWN STYLE VEHICLE TOWED 2NOn fBLIN tIHNK RS GOVT.VEHIICL✓ 5 7 34 ❑ DAMAGE II1I._IIII tlAlVt(t ccJllu—'II REGISTERED OWNER INFO DAMES CARLSON 10334151STAVE SE RENTON WA 980595720 D:4252040684 VEHICLE NO. 1 ❑ SHADE 1N DAMAGED AREA 35 2 LIABILITY INSURANCE INSURANCE CO 3 14 USAA 00769 82 39U 71016 �q IN EFFECT &POLICY# �9TOP VEHICLE YESCHARGE ❑ 36 EGnu V [:]NO[:] CITATION# 10 BOTTOM UNIT ` MOTOR PEDAL; PEDESTRIAN PROPERTY � DAM THR OLD MET PHONE VEHICLE LJ CYCLE OWNER YES NO 16� LAST NAME AHMED FIRST NAME SAMROSE MIDDLE! ' N INITIAL 17❑ STREET El 5222 NE 9TH PL CITY RENTON ST', WA 980594479 37 ZIP NEW ADDRESS ❑ 18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED ❑ 38 1NTERLOCKYEs No INTERLOCK YES NO vEs No 19❑ DRIVER'# ❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U MEET INJURYCLASS 1 NATURE OF INJURIES ❑ 40 21❑ LICENSE,CLW0597 TATf WA vIN# 1HGCV1F50JA159718 ❑ 41 PLATE# TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42 23 43 TRLR RLR VIN#. '[N#, VEH.YEAR 201$ MAKE HOND MODEL ACCORD STYLE DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44 YES O 24 REGISTERED OWNER INFO SAMROSE AHMED 5222 NE 9TH PL RENTON WA 980594479 D:7188830734 VEHICLE N0.2 SHADE IN DAMAGEaAREA LIABILITY INSURANCE ✓ INSURANCECO PROGRESSIVE 478 788 182 2 3 �d IN EFFECT &POLICY# t 4TOP 5 —1-1 ❑ CITATION# CHARGE 25 tOBOTTOM EEcnEEv YES NU s e 7E1FFLIIER�S NAME(PRINT) 26 OFFICER PHONE BADGE OR ID# JAGENCY VERTON 2517 WA0171300 PART A . PAGE 01 OF 9000-345-159(R 11(181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF89256 COLLISION REPORT III III III III III 111 1591972 CASE# 25-3683 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) UNKNOWN ADDRESS&PHONE Q.O.B. - SEX U MMDDYYYY PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ �; PCs. USE CLASS ----� :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 ❑ ❑ PC& 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 04-28-25 08:51 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE G.BARFIELD 6476 1 51712025 9:18:34 AM BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:22 Pry/ TIME POLICE ARRIVED i 1:23 PM PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F5 REPORT NO.1 EF89256 CASE# 25-3683 OF COLLI ION 04/25/25 13:20 OF COLLISION NARRATIVE red unit2 and wit It from h to ne ss unit 1/wht ran red unit 1 hit red bounced off into cor pole RTF Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash near the intersection of NE Sunset Blvd and Hoquiam Ave NE. I contacted the driver of unit 2 who told me he was making a left from northbound Hoquiam to Sunset Blvd on his green light when he was hit from behind by unit 1. He told me unit 1 bounced off the back of his vehicle and then contacted a street light pole and finally coming to rest in the east bound lane facing westbound near the intersection of Field Ave NE. He did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 1 ID'd by picture WADL. He told me he did not have much recall of the crash. He told me in all the years he has been driving he has never had a crash. A quick glance at his drivers license revealed his was born in 1925, so he has had a life time of safe driving. Unit 1 was checked and released onscene by Renton Fire. He said he knee was sore but did not need additional checks. The light pole he hit was struck dead center between his headlights, the pole fell across his roof top and back window and trunk. Unit 1 did require a tow truck for damages. I notified the City of Renton streets who removed the light pole from the roadway. I provided a copy of the info exchange to the City Workers onscene for insurance. I did not cite unit 1 ref this collision but I did submit him for a drivers re-exam. 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 4/28/2025 PAGE 3 OF 5 44SUPPLEMENTAL REPORT NO. EF892556POLICE TRAFFIC 1 27 COLLISION REPORT CASE#+ 25-3683 1 COMMERCIAL MOTOR CARRIERT INTERSTATE INTRASTATE L UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER 7 ADDRESS CITY ST ZIP NAME # PLACARD 4 GWVR ❑ NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR E] PEDAL- ("'� PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ 11 N IT 3 VEHICLE I_I : CYCLE LJ PEDESTRIAN OWNER Iv I'.. YES NO D:4254307400 29 FIRST NAME MIDDLE LAST NAME ', RENTON + CITY OF INITIAL STREET 30 NEW AnnRFs. 3055 NE 2ND ST CITY RENTON ST WA ZIP 98058 5 PRESENT MEDICALTANSPORTED 1 31 CDL IGNITION RE27UIRED IGNITION INTERLOCK YES R '.INTERLOCK YES N IEs N,.. DRIVER'S STATE SEX U MMD DWY -� C LICENSE 7 ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATUREOFINJURIES USE CLASS 8 ❑ 1 32 LICENSE: TnT VIN PLATE# 9 TRAILER TRAILER 2 PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN..#. VIN.# 11 VEH.YEAR MAKE I MODEL STYLE VEHICLE TOWS E T ABLIN TOWED BY arnir.VEHIC!F FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 SHADE DAMAGED AREA 12 LIABILITY INSURANCE❑ 4 FROM TO INSURANCE CO IN EFFECT &POLICY# 13 vewcLe YES NO CITATION# CHARGE 1CkBOTTC)M m 34 IFGALIY sTn"olNc R T 6 14 ❑ UNIT' MOTOR PEDAL- PEDESTRIAN: El PROPERTY ❑ DAMAGE THRESHOLD MET PHONE El 35 VEHICLE CYCLE OWNER YES NO 15 LAST NAME FIRST NAME ❑ID 30 AL ❑ STREET 16 NEW A F-1 CITY ST ZIP CDL IGNITION RrOUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YES .01:1 .INTERLOCK YES NO YES NO 17 37 DRIVER'S STATE I SEX D.O.B 18 ❑ LICENSE'.,# MMDDYYY ON DUTY STATUS' AIRBAG RESTR. EJECT HELMET INJURY NATURE of INJURIEs ❑ 38 USE CLASS 19 ❑ ❑ 39 LICENSE uIN# PLATE# TA 20 TRAILER TRAILER 40 PLATE# STATE PLATE# STATE 21 TRLR TRLR 41 VIN# TR R 42 22 VEH.YEAR MAKE I MODEL STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT � &POLICY# 1 _4 T()F'`"' �. 44 vewcLe ❑ ❑ CITATION# CHARGE 70 k3C1TT061 24 LECALLy YES NO srnNOlNc S L 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT, K LEVERTON 04-28-25 08:51 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED BADGE ORID# BARF/EL 5n/2 PAGE 26 2517 IWA0171300 AP 025 OF 3000-345-013(R 11/181 REPORT NO. EF89256 CASE# 25-3683 DATE AND TIME 04/25/2513:20 OF COLLISION i„ hi c b $ti ry t a:xt 1 PAGE 5 OF 5