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HomeMy WebLinkAbout25-6625 )STATE T �cN 6 0 27i t Oc� RA EG16652 COLLISION REPRT 1591971 CASE# 25-6625 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOL`CO A`OENC'Y 4100 3 COUNTY RD INVOLVED 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 CDLL.ISION'. 07 - 31 - 2025 1700 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ S 3RD ST BLOCK NO. e 700 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 FEET e S 8 W e BURNETTAVES 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:2066501410 0 1 30 5 LAST NAME WAGGEH FIRST NAME FATOUMATA MIDDLE 1 1 2 31 INITIAL STREET ❑✓ 12777 SE 174TH ST CITY RENTON ST WA ZIP 98058 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NO✓ INTERLOCKYEs No✓ YES D Nor,/ 8 DRIVER'CENS STATE WA SEX F MMOCSYY' 01 — 10 — 1987 1 2 32 9� ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT, 1 HELMET 2 INJURY 7 NATURE of N OF C 2 USE ;CLASS COMPLAINT OF CHEST PAIN LICENSE', CBJ3181 STATE WA VN# 2C4RDGCGXGR181296 3 10 PI ATP tt TRAILER STATE TRAILER ..STATE 11 2 $ PLATE# PLATE# ROM TO TRLR TRLR 7 3 33 1 2 5 VIN#'' VIN '... : FROM TO 2 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 v 1 $ 34 GOVT VEHICLE 13 1 2016 DODG GRAND VN DAMAGE YES TO d gWg MEYERS YEs❑ No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 ALLSTATE 9699658t2 IN EFFECT &POLICY# 4TOP vEnic�E CHARGE 5 36 Lemur YES❑NO❑ CITATION# 7 0 80TTOM 15❑ STM ING e MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE UNIT 02 Q ❑ PEDESTRIAN ❑ D:3606017019 VEHICLE CYCLE OWNER YES'I NO 16� LAST NAME DOWN FIRST NAME MADELINE MIDDLEI J INITIAL STREET ❑ 17 ' 2 ❑ 444 55TH AVE SW CITY SEATTLE ST, Wq ZIP 98116 4 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIOALTRANSPORTEDI 38 INTERLOCKYEs No✓ INTERLOCK YES NO✓ rEs NO I✓ 19 DRIVER'S STATE WA SEX F I D.O.B. 07 20 1994 39 LICENSE# MMDDYY - 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS COMPLAINT OF NECK/HEAD PAIN 21 LICEN� BTR7732 TaTE WA VIN# 2T3RFREV1HW641762 41 PLATE 22❑ PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2017 MAKE TOYT MODEL RAV4 STYLE SV VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24= DAMAGE YES�/ No GENE MEYERS YES No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO,2 SHADE DEGED AREA 4 LIABILITY INSURANCE INSURANCE CO pEMCO CA1850t82 IN EFFECT &POLICY#CITATION. C;QvewAa r CHARGEYES❑ NLJ 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY JAMAAL KEARSE 26 12994 WA0171300 PART A PAGE 01 OF 3000-345-159(R 11/181 POLIICFETRAFFICN CORRECTION REPORT NO. EG16652 COLLISION REPORT III III III III III 111 1591972 CASE# 25-6625 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME WAGGEH AISHA (LAST,FIRST MIDDLE INITIAL} ADDRESS&PHONE# D O 12777 SE 174TH ST RENTON WA 98058 SEX' F MMoovYvv O6 - 25 - 2001 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES Ej 1 POS. 3 6 4 1 USE 2 CLASS 1 --� 'NAME LAsr F RST,MIDDLE INITIAL) WAGGEH MUSSA ADDRESS&PHONE# 12777 SE 174TH ST RENTON WA 98058 SEX' M D•O.B. 09 _ 08 _ 2016 MMDDYYYY SEAT HELMET INJURY NATURE OF INJURIES PASSENGER �WITNESSEl I UNIT# i 1 POS. 4 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� NAME MIDDLE INITIAL) WAGGEH MA►MUNA ',(LAST,FIRST, AODREss a PHONE# 12777 SE 174TH ST RENTON WA 98058 SEX F D.O.B. 12 _ 29 _ 2020 MMDDYYYY PASSENGER Z WITNESS UNIT# 1 SEAT 9 AIRBAG:6 RESTR. 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES Q,. POS. USE '.CLASS COMPLAINT OF EYE PAIN 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. JAMAAL KEARSE 07-31-25 07:29 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE 8/6/2025 8:08:26 PM J.CHRISTIANSEN 10437 BADGE OR ID# 12994 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:03 PM TIME POLICE ARRIVED 5:04 PM PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 57 POLIICFETRAFFICN CORRECTION REPORT NO. EG16652 COLLISION REPORT III III III III III 111 1591972 CASE# 25-6625 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME EARL JAN L (LAST,FIRST MIDDLE INITIAL} ADDRESS&PHONE# 320 S DIVISION ST AUBURN WA 98001 SEX' M MMooYYYv 03 - 29 - 1959 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES �' POS. USE CLASS ATU 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# S ' D.O EX .B.MMDD -F L----------� YYYY EAT HELMETNJURY URE OF PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B.M -T L----------� MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY rNATURE OF INJURIES ❑ Q' POS USE GLASS — ----� 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. JAMAAL KEARSE 07-31-25 07:29 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 8/6/2025 8:08:26 PM BADGE OR ID# 12994 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:03 PM TIME POLICE ARRIVED 5:04 PM PART B 3 Do-3mx-,ao(Rtrras) PAGE 37 OF 57 REPORT NO.` EG16652 CASE# 25-6625 O COLLI COLLISION TIME OF 07/31/25 17:00 COLLI NARRATIVE Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State of Washington. This incident was captured on my body worn video camera and in-car cameras. This report is a summary of events that occurred and is not an exact sequencing of events. On 7/31/2025, at approximately 1700 hours I was dispatched to a report of a collision at the intersection of S 3rd St and Burnett Ave S. Dispatch advised 2 vehicle collision with injuries blocking the roadway. At approximately 1704 hours I arrived on scene. I observed both Unit 1 and 2 in the intersection. Unit 1 had significant damage to the front bumper and front driver side. Unit 2 had significant damage to front passenger side bumper. All involved parties were out of the vehicle and on the sidewalk when I arrived. Unit 1 had four occupants and Unit 2 had one occupant. Renton Fire responded and evaluated all parties involved. I spoke with the driver of Unit 1 and she relayed the following information. She was driving eastbound in lane 1 of 2 approaching Burnett Ave S. She advised she had a green light and entered the intersection. She then observed Unit 2 driving southbound on Burnett Ave S enter the intersection. She struck the front passenger side of Unit 2 with the front driver side of Unit 1. The driver of Unit 1 had complaints of chest pain. Unit 1 had airbag deployment and had to be towed. Asiha Wagget DOB 6/25/2011 was in the front passenger seat of Unit 1. She stated they had a green light. She had no complaints of injuries. Mussa Wagget DOB 9/8/2016 was in the middle-left seat of Unit 1. He did not see anything and was injured. Maimuna Wagget DOB 12/29/2020 was in the right rear passenger seat of Unit 1. She did not see anything. She had complaints of eye pain but stated it went away. The driver of Unit 2 relayed the following information. She was driving southbound in lane 1 of 1 on Burnett Ave S. She had a green light and entered the intersection. She saw Unit 1 eastbound on S 3rd St enter the intersection. She did not have enough time to react. Unit 1 struck the passenger side of Unit 2 with the front driver side of Unit 1. The driver of Unit 2 complained of pain in her neck/head area. Unit 2 did not have airbag deployment but had to be towed. Jan L. Earl DOB 3/29/1959 was a witness of the collision. Jan stated that he saw Unit 1 struck the passenger side of Unit 2 with the front driver side of Unit 1. Jan also advised that he saw Unit 2 had the green light traveling southbound on Burnett Ave S. Jan did not provide a phone number. 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 J. Kearse #12994 7/31/2025 1914 Hours Renton, King County, Washington PAGE 4 OF 5 REPORT NO. EG 16652 CASE# 25-6625 DATE AND TIME i 07/31/25 17:00 OF COLLISION It c ,r „r a 4 1 �ky}Ut, u tea y a Y I 444 ;k ,� CR pa YAMS k �2 A �g k i� v PAGE 5 OF 5