HomeMy WebLinkAbout25-4801 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EF98097
COLLISION REPRT 1591971
CASE# 25-4801 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4100 3[--�
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 02 - 2025 1116 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
S 180TH ST BLOCK NO. e 8272 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064540205 0 1 30
5 LAST NAME HAMID ZADA FIRST NAME AMRULLAH MIDDLE 1 2 31
INITIAL
STREET ❑ 27614 PACIFIC HWY S APT S215 CITY FEDERAL WAY ST WA ZIP 980033529 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NL INTERLOCK YEs NO YES NO
8 DCIENS STATE WA SEX M MMOCSYY' 05 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 N USEET CLASS 1 NAruRE of NJURIEs 2
LICENSE, CRU4413 STATE WA vN# JTMABACA3SA092811 3
10[9� PI ATP tt
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 7 1 33
12 3 5 VIN# VN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 Y GO VEHICLE 34
13 4 2025 TOYT BZ4X DAMAGE ves ✓ No � g MEYERS YesS) 3 7 No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3
14 LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 995610736 4
IN EFFECT &POLICY# 4TOP _
srgNOLNG
Yes❑NO❑I CITATION# 5A0512660 CHARGE FAIL YIELD LEFT TURN MOTOR s o ooTrob 36
15
III MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT Q2 VEHICLE CYCLE nWNFR YES)/ NO D:2062988270
16�
LAST NAME MUGO FIRST NAME WALTER MIDDLE K
INITIAL
STREET ❑ 37
17 '❑ 29806 18TH PL S CITY FEDERAL WAY ST, Wq ZIP 980034242
NEW ADDRESS
1g❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPt'ORTED: 38
INTERLOCKYEs No INTERLOCK YES NO ves ND
19 DRIVER'S STATE WA SEX M I D.O,g, 08 O6 1971 ❑ 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 7 ❑
USE CLASS COMPLAINT OF HIP PAIN
21 LICENSLATE E CLM6450 rarE WA vIN# JTDZN3E000J049564 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q16 MAKE TOYT MODEL PRIUS V STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE vEs�/ No GENE MEYERS ves No�/
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO FARMERS INSURANCE 543896149
IN EFFECT &POLICY# 4TOP
vemcLE
LEGALLY YES❑ N`LJ
,.I—I CITATION# CHARGE t080TTOM
25 a
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. EF98097
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4801
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 06-02-25 12:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/5/2025 3:05:13 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:17 AM TIME POLICE ARRIVED 11:28 AM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
EAN
REPORT NO.` EF98097 CASE# 25-4801 O OF COLLI COLLISION TIME 06/02/25 11:16
COLLI
NARRATIVE
CC 25-4801
On 6/2/2025 at 1117 hours I was dispatched to a motor vehicle collision at 8200 block of S 108th St in
the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling West on S 180th St in the #1 lane approaching the 8200 block.
Driver 1 stated that he was stopped in the 2 way center turn lane facing East preparing to perform a
lefthand turn to proceed North into the Ikea parking lot at the 8200 block of S 180th St.
Collision
Driver 2 stated that as he entered the 8200 block, Unit 1 turned in front of him from the 2 way center
turn lane and he did not have time to stop. Driver 2 stated that the front bumper of Unit 2 collided with
the front passenger side wheel and fender of Unit 1.
Driver 1 stated that traffic in the #2 lane allowed him through and he began to perform his lefthand
turn. Driver 1 stated that he was unable to stop and the front bumper of Unit 2 collided with the front
passenger side wheel and fender of Unit 1.
Injuries
Driver 2 complained of hip pain and was self transported to the hospital.
Vehicle Disposition
Both vehicles were towed from the scene.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a vehicle
intending to turn to the left within an intersection or into an alley, private road, or driveway shall yield
the right-of-way to any vehicle approaching from the opposite direction which is within the intersection
or so close thereto as to constitute an immediate hazard.
Driver 1 was cited per RCW 46.61.185.
1 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 11:54 on 6/2/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF98097 CASE# 25-4801 DATE AND TIME i 06/02/25 11:16
OF COLLISION
co
w+
+
� re
P u
+
y�
t=.
S
df
Ea
C
K�c
u l<
Ct.
y +.
tp
PAGE 4 OF 4