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
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