HomeMy WebLinkAbout25-4893 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG09342OLCERA
COLLISION REPORT 1591971
CASE#I 25-4893 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY. 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL UNITS#OF 02 SO7RUCK CONCRETE/JERSEY BARRIER 5 1 28
RESERVATION I 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
OOLLISION' 06 - 05 - 2025 1018 17 =.= S 8 W e IN OF 8 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
FACTORYPL N
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e N 4TH ST
0 1 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO O 1 30
6❑ LAST NAME UNKNOWN FIRST NAME UNKNOWN MIDDLE 1 2 31
INITIAL
STREET ❑' UNKNOWN CITY( SEATTLE
NEW ADDRESS ST ZIP UNKNOWN 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NOS/ I INTEPLOCKYESD NO Z YES F No,/
8 LCEVERS ENSE# STATE SEX M MMDDYY+ —=— 1 2 32
9 ON DUTY STATUS AIRBAG 4 RESTR 9 EJECT 1 HELMET 2 ICNJAUSRS 0 NATURE OF INJURIES 2
LICENSE, 29BD22 STATE SD VIN# 3GNKBDRSlLS580135 3
10 PI ATP rt
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR rRLR 7 3 33
12 3 5 vIN# vIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 3 2020 CHEV BLAZER 5D DAMAGE YES NO ✓ YEs❑ No 4 $ 34
REGISTERED OWNER INFO RONALD BERG 406 S VIOLA ST MILBANK SO 57252 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO
IN EFFECT &POLICY# 11 9TOP
vEnicLE CHARGE S 36
LecnLLY YES[:]NO[:]
CITATION# HARE 7 0 BOTTOM
15❑ STM ING s 7 e
MOTOR PEDAL- : PROPERTY DAM THR OLD MET PHONE
UNIT 02 Q ❑ PEDESTRIAN ❑ D:9299881533
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME LEE FIRST NAME MOHAMMAD MIDDLE' M
INITIAL
STREET �/ ❑
17 ❑ 4435 35TH AVE CITY SEATTLE ST, WA ZIP 98126 g 37
NEW AbbRESS ':
18❑ CDL IGNITION REQUIRED IGNI"i'ION PRESENT MEDICAL TRANSPC)RTED. 38
INTERLOCKYES No� INTERLOCYEs No�/ yEs No
19 DRIVER's, STATE TX SEX M o.0.6. 01 13 1991 39
LICENSE# MMDOYY -
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 CLAY 1 NATURE OF INJURIES 40
SS
21 LICENSE I PATE# RZF2792 rare TX vIN# 1G1ZD5ST4JF285115 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 201$ MAKE CHEV MODEL MAUBU STYLE SD VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO KEYRAJOHNSO144353577HAVES SEATTLEWA98126 0:8174802389 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO FOREMOST COUNTY MUTUAL INSURANCE COMPANY G01557716300
IN EFFECT &POLICY# 9TOP
vewaE ❑ ,.—I CITATION# CHARGE 1060TTOM
EEGnEEv YES N`[
25 F
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF 11 3000-345-159(R 11/181
POLIICFETRAFFICN CORRECTION REPORT NO. EG09342
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4893
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El 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
On 06-05-2025 at about 1023 hours, Officers were dispatched to the intersection of N 4th St and
Factory Ave N, with in the City of Renton, King County, Washington.
Upon arrival I learned that the driver of unit 1 had fled on foot. We were not able to locate him.
The driver of unit 2 said he did not remember what occurred. He believes he was driving north on
Factory Ave N. He said he did not remember how the collision occurred. He was not familiar with
Washington and was following his GPS from Seattle to Renton for a job interview. He took 190 to
Hwy 405 southbound to get to Renton. If he followed his GPS correctly, he would not be on Factory
Ave N. There was no debris near Factory Ave N. I did find debris on N 4th St east of Factory PI N.
also saw tire marks from unit 1 as it crossed over the yellow divider C curbing as it spun.
It appears unit 2 struck unit 1 on unit 1's passenger side.
There was damage to the front of unit 2.
The driver of unit 2 said he can identify the driver of unit 1.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 06-14-25 04:54 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
J.TRADER 4553 DAT 7/13/2025 6:09:25 PM
BADGE OR ID# 10065 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 10:23 AM TIME POLICE ARRIVED 10:24 AM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG09342 CASE# 25-4893 DATE AND TIME 06/05/25 10:18
OF COLLISION
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