HomeMy WebLinkAbout25-4532 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF98480oc� RA
COLLISION REPORT 1591971
CASE# 25-4532 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 05 - 23 - 2025 1831 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
AIRPORT WAY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 2001.1 00 FEET e✓ S 8 W e✓ LAKE AVE S
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533946443 0 1 30
5 LAST NAME MOHAMOUD FIRST NAME TAQWO MIDDLE M 1 2 31
INITIAL
STREET ❑✓ 29008 122ND WAY SE CITY;AUBURN ET WA I ZIP; 98092 2
NEW ADDRESS
7 +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 3
INTERLOCKYEs NO✓ INTERLOCKvEs NO✓ vEs NO;✓
8 DRIVER # STATE WA SEXI F MMDDYY' 04 — 10 — 1991 1 2 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT ', ) HELMET 2 INJURY 6 NATURE OF INJURIES 2
USE ,CLASS PAIN IN RIGHT SHOULDER CUT ON ARM
10 LI ENSE'tI, RKD5240 STATE NC VIN# 3GNAXHEG8SL224392 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR zRLR 3 5 33
12 3 5 VIN# VIN#
FROM TO
HICLE
13 4 VER YEAR 2025 MAKE CHEV MODEL EQUINO STYLE SD DAMAGE TOWED NO�iS46LIN T(QiMYMEYERS GO NO✓ 3 7 34
DAMAGE IIII._IIII
REGISTERED OWNER INFO TAQWO MOHAMOUD 29008122ND WAY SE AUBURN WA 98092 D:2533946443 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EFFTY INSURANCE� STATE FARM 491-8926-E15478-001
IN EFFECT &POLICY# 4TOP
V""' CHARGE 36
LE,,ALLY YES❑NO❑ CITATION# 7 0 BOTTOM
15❑ STM ING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO THR D:4252609572
16�
LAST NAME SANDERS FIRST NAME SHANA MIDDLE M
INITIAL
17 F1 STREET ❑❑ 1316 MONROE AVE NE CITY RENTON ST, WA ZIP 980563315 4 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYES NO✓ INTERLOCI£YES NO✓ YEs NO'✓
19 DRIVER'S ' STATE WA SEXI F I D.O,B. 03 20 1971 � 39
LICENSE# MMD6YY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES 40
USE CLASS BACK PAIN AND NECK
21 LICENSLATE E D00926A rare WA vIN# 3TMGZ5ANXNM515023 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE TOYT MODEL TACOMA STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ NO GENE MEYERS vEs No✓
REGISTERED OWNER INFO MARY MITCHENER 1316 MONROE AVE NE RENTONWA98056 VEHICLE NO.2
SHADFY DAGED AREA
4
LIABILITY INSURANCE INSURANCE CO SAFCO H2419515
IN EFFECT &POLICY# 9TOP
VEHICLE
❑ ,J—I CITATION# CHARGE t080TTOM
HE
GnLLY YES N`[
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEVIN PETERSON 12808 WA0171300
PART A PAGE 01 OF
3000-345-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF98480
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4532
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 NJURY NATURE OF INJURIES
POS. ' USE CLASS 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 CIASS ----�
: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
I was dispatched to a collision on 05/23/25 at 1832 hours on Airport Way and Lake Ave S, in city
Renton, King County WA.
Unit 1 RKD5240 Driver: Taqwo M. Mohamoud (DOB 04/10/1991)
Unit 2 D00926A Driver: Shana M. Sanders (DOB 03/20/1971)
Unit 1 was in lane one traveling West on Airport Way. Unit 1 wanted to make a U turn and go to the
gym so she tried to make a left turn into a parking. Upon Unit 1 turning Unit 2 was traveling West
bound and got into the turning lane to follow the Detour sign. When coming close to Lake Ave S Unit
1 pulled across the turning lane to pull into the parking lot and Unit 2 crashed into the side of Unit 1.
Both drivers had pain and unit 1 had a cut on her left arm. Fire checked on both units and advised the
go to the hospital. Both drivers refused transport to the hospital on scene.
Both drivers were given an information exchange with case number on it.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 05/24/2025, 0012 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 05-24-25 02:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 6/6/2025 8:46:19 PM
BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:32 PM TIME POLICE ARRIVED i 6:34 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. E F98480 CASE# 25-4532 DATE AND TIME 05/23/25 18:31
OF COLLISION
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