HomeMy WebLinkAbout25-5606 )STATE
TFcN 5 6 27i t
Oc� RA EG04779
COLLISION REPRT 1591971
CASE# 25-5606 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4100 3
COUNTY RD ❑ NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 03 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
COLLISION' 06 - 28 - 2025 1135 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
SW 7TH ST BLOCK NO. e 100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 00 FEET e✓ S 8 W e HARD/E AVE SW
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHiOLE ❑ CYCLE ❑ YEs Vl No D:2533475296 0 7 30
6 LAST NAME BYERS FIRST NAME ROBERT MIDDLE L 1 1 2 31
INITIAL
STREET 3847 19TH AVE SW CITY SEATTLE ST WA ZIP 98126 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NOR] INTERLOCKYEs Na�/ YES R Nor,/
8 LICIENSE#RVER' STATE WA SEX M MMOCSYY' 04 — 11 — 1962 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of N3uRIEs 2=
10 LICENSE
ti� D37758G STATE WA vN# 3C7WRVTGXGE120009 3
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
rRLR TRLR 3 7 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 3 9 34
13 2 2018 RAM PROMA DAMAGE YES DNO YES NO
REGISTERED OWNER INFO PACIFIC SIDING&WINDOWS 4416D 40TH AVE SW SEATTLE WA 98116 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 PROGRESSIVE 03708097-9
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Le ALLY YES❑NO❑ CITATION# 70 80TTOM
15❑ sTnNowc 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT OZ VEHICLE ❑ OVDLE' ❑ ❑ PROPSnwNF YEs�/ No D:2063964805
16�
LAST NAME ADEM FIRST NAME JEMAL MIDDLE K
INITIAL
STREET ❑ 37
17 '❑ 3333 RA INIER AVE S APT 211 CITY SEATTLE ST, WA ZIP 981446817
NEW ADDRESS
18❑ CDL IG EQUIRED IGNITION R IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs No INTERLOCK YES N.F,-/Jl
YEs Nail
19 DRIVER'S STATE WA SEXM D.O.B. 01 01 1971 39
LICENSE# D.OB,Y —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSE CKJ7641 TATE WA vIN# 4T3BK11A49UO10247 41
22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2009 MAKE TOYT MODEL VENZA STYLE 5p VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO�/ YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADEDAMAGAREA
3
LIABILITY INSURANCE INSURANCECO STATE FARM 4100108-813.47A
IN EFFECT &POLICY# 9TOP
Veeiae ,J—I CITATION# CHARGE t08OTTOM
LecnLLY YES N`.LJ
25 '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.STEED 8770 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG04779
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5606
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} MOHAMMED OMAR HAWA
(LAST,FIRST,
ADDRESS&PHONE# D(�� '.
3333 RAINIER AVE S APT 211 SEA TTLE WA 981446817 2064079840 SEX' F MMDDYYYv 04 — 12 1— 1974
SEAT : HELMET INJURY NATURE OF INJURIES
El I
PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS ;7 SORE CHEST FROMSEATBELT
'NAME
LAsr F RST,MIDDLE INITIAL) HUEMAN GERALD T
ADDRESS&PHONE# D C,B
7026 S 116TH ST SEATTLE WA 98178 2068541104 SEX U MMDDVVYv 11 _ 18 _ 1963
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M F L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
On 06/28/25 at about 1144 hrs I arrived in the 100 block of SW 7th St for an Injury Collision, in the
City of Renton, County of King, and State of Washington. All involved were identified by their WADL.
Unit#3 was stopped for traffic in the WB inside lane of SW 7th St trying to make a left turn into
Popeyes Chicken. Unit#2 was stopped behind Unit#3. Unit#1 was traveling WB on SW 7th St in the
inside lane when the driver did not see the stopped traffic. Unit#1 collided with the back of Unit#2
which in turn was pushed into the back of Unit#3. The driver of Unit#3 complained of dizziness and
the passenger of Unit #2 complained of chest pains from the seatbelt. Both were treated by Renton
Fire. The witness advised he was in the EB inside lane of SW 7th St next to Unit#3 when he
witnessed the collision. He said he did not think the driver of unit#1 even saw the stopped traffic
when he rearended unit#2 which was pushed into the rear of Unit #3.
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. The video was uploaded to evidence.com.
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 Steed on 06/28/25 1246 hrs, Renton Washington
Cassidy Steed/8770
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 06-28-25 12:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 6/28/2025 1:06:31 PM
BADGE OR ID# 8770 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:39 AM TIME POLICE ARRIVED 11:44 AM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 47
SUPPLEMENTAL REPORT No. EG04779
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE#+ 25-5606
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # NAME IF PLACARD
GWVR � NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
}j� PEDESTRIAN �/ D:2063964805
5 UNIT vT 3 VEHICLE CYCLE C) C� OWNER �' YES NO
0 7 29
LAST NAME GONZALES FIRST NAME MARNIE MIDDLE G
INITIAL
STREET 30
NFW ADnRFS.,p 7710 48TH AVE S CITY SEATTLE ST WA 7JP 981184104
6 ❑ 1 1 2 31
CDL IGNITION REQUIREt] IGNi71ON PRESENT MEC7ICALTANSPORTED.
INTERLOCK YES NO ..INTERLOCK YES NO YES N
G
DRIVER'S WA SEX F D.O,Ei 07
7
LICENSE MMDDwv — O6 — 1967
HELMET I INJURY NAruRE OFINJURIEs
ON DUTY STATUS: AIRBAG 2 RESTR. ¢ EJECT 1 USE 2 GLASS 7 DIZZINESS
LICENSE I CRT2459 W VIN WBY83FB07RFS62861PLATE#
9 Fq] STATE TRAILER TRAILER 2
PLATE#r PLATE# STATE
10 ❑ TRLR TRLR
VIN.# VIN.#.
11 3 5 VEH.YEAR2024 MAKE BMW MODEL14 I STYLE 4D VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFORONEO GONZALES 771048TH AVE S SEATTLEWA98118 3 9 33
12 � SHADE IN DAMAGED AREA
4 FROM TO
INSURANCE CO
LIABILITY INSURANCE SAFECO H2594340
IN EFFECT � &POLICY# �GQO
34
13 c YES NO CITATION# CHARGE
iecauv
sTnNoimc � �
MOTOR PEDAL- ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YESF-1 NO
36
15 LAST NAME FIRST NAME NIDT ALE
❑
16 ❑ STREET CITY ST ZIP
NEW AODRBsa
GDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES[]NO INTERLOCK YES NO :YES NO,
17 37
LLIRIVERS ICENSE# STATE SEX MMDDY Y
18 ❑ ❑
HELMET INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ LICENSE TAT viN ❑ 39
PLATE# #
20 ❑ TRAILER TRAILER ❑ 40
PLATE#, STATE PLATE,# STATE
21 ❑ TRLR TRLR 41
VIN#j VIN#:
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN 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 I &POLICY# I.C;Q
5 44
vEHic�F ❑ ❑ CITATION# CHARGE
24 I..EG_ VES NO
STIWDING 8 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 06-28-25 12:49 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OR ID# 8770 O#RI WA0171300 APSKELTON 6122812025
PAGE OF�
3000-345-013(R 11l18)
REPORT NO. EG04779 CASE# 25-5606 DATE AND TIME 06/28/25 11:35
OF COLLISION
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