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Home My WebLink About25-3330 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG2084OLCERA COLLISION REPORT 1591971 CASE# 25-3330 2 INTERSTATE CITY STREET FIRE ❑ RESULTED LVED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAI-AGENCY 4200 3 COUNTY RD NT&RUN CODING PRIVATE WAY 2 TOTAL#OF OBJECT 5 1 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s on' 04 - 13 - 2025 1233 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ N 4TH ST BLOCK NO. e 1200 .� 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �. FEET e S 8 W e PARK AVE N 0 1 29 MOTOR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2537660553 0 6 30 6 LAST NAME RAJAB ZADEH FIRST NAME MORTEZA MIDDLE t 1 2 31 INITIAL STREET ❑ 12450 SE 288TH PL CITY;AUBURN ST WA ZIP 98092 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3 INTERLOCKYES NOW INTERLOCK VEs No YES No Z/ 8� DCIENSE# STATE WA SEXI U MMDDYY' 01 - 01 - 2007 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 6 RESTR 9 EJECT 1 N USEET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, CLH2948 STATE WA VIN#; 4T1BF1FK1FU951892 3 10 Fl I PI ATP rt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR TRLR 3 1 7 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 2015 MAKE 7.0�- MODEL CAMRY STYLE SD VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 3 7 34 13� DAMAGE YES II_II NO YESII_I) NO REGISTERED OWNER INFO MOSTAFANAJIBULLAH12450SE288THPL AUBURNWA98092 D:2536569098 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 1 LIABILITY INSURANCE INSURANCE CO 4 14 AMERICAN FAMILY INSURANCE 41087-72138-91 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 Lemur yes❑NO❑ CITATION# t a 80TTOM 15❑ sTnNowc 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR D:2065490487 16� LAST NAME DE SOUSA PROULX FIRST NAME HELENA MIDDLE A INITIAL 17 F1 STREET ❑ ❑ 7902 168TH AVE NE#201 CITY REDMOND ST, WA ZIP 98052 4 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSP(7RTEd'. 38 INTERLOCKYES No INTERLOCK YES NO vEs No 19 DRIVERS ' STATE WA SEX U DOB4O9 01 2006 � 39 LICENSE# MMDDYY I — 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H ET 2 INJUSE 6Y 1 NATURE OF INJURIES 40 21 LICENSE 1 PLATE# CBL0929 rare WA vIN# 3N1AB7APXHY299746 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2017 MAKE pJJ$$ MODEL SENTRA STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO MICHAEL PROULX 7902168TH AVE NE 4201 REDMOND WA 98052 D:2063342434 VEHICLE NO.2 SHADE IN DAMAGEAREA 2 3 LIABILITY INSURANCE INSURANCE CO STATE FARM 567.3358-C26.47B IN EFFECT &POLICY# I STOP VEHICLE ❑ ,J—I CITATION# CHARGE to BOTTOM LEGn��Y YES N`.LJ 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 MIRIAM LONG 12790 WA0171300 PART A PAGE 01 OF 3000-348-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG20854 COLLISION REPORT III III III III III 111 1591972 CASE# 25-3330 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) PROULX MICHAEL J ADDRESS&PHONE# D.0 7902 168TH AVE NE#201 REDMOND WA 98052 2063342434 SEXi U M B.Y 04 - 08 - 1976 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES 2 POS. 11 2 4 1 USE 2 CLASS 1 �----� :NAME Lnsr EIRST,MIDDLE INITIAL) DE SOUSA ALEXANDRA A ADDRESS R PHONE# D O B 7902 168TH AE NE#201 REDMOND 98052 SEX'' U MI MDDYYYY 11 _ 29 _ 1977 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. ' 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� :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 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. MIRIAM LONG 04-13-25 02:16 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 812012025 9:15:37 AM BADGE OR ID# 12790 ORI# WA0171300 TIME POLICE DISPATCHED 12:37 PM TIME POLICE ARRIVED i 12:40 p�q PAST B 3 Do-lmx-attar gt 1Mfft PAGE 2�OF 4 REPORT NO. EG20854 CASE# 25-3330 DATE OF COLLI r�510NN + 04/13/25 12:33 L1 NARRATIVE Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 4/13/2025 at about 1237 hours I responded to a collision at N 4th St/Park Ave N. I arrived at the location and observed both vehicles blocking west bound traffic on N 4th St at Park Ave N. Unit#2 had significant damage to rear end and Unit#1 had damage to the front end and airbag deployment. Renton Fire Department responded to the location and medically evaluated the involved parties. I contacted the involved parties, who were walking around and had no obvious injuries. There, I collected the involved parties driving documents and the independent recollection of events leading up to the collision. The driver of Unit#1 (Morteza) said he was the sole occupant of the vehicle and that prior to the collision he was driving west on N 4th St behind Unit#2 approaching Park Ave N. As he approached the light it turned yellow and it appeared as if Unit#2 was going to drive through the intersection, but they stopped suddenly causing him to collide with the back of their vehicle. The driver of Unit#2 (Helena) said she had two other occupants in the vehicle, Alexandra (front right) and Michael (back), and that prior to the collision she was driving west on N 4th St approaching Park Ave N. She could not recall what the light was, but remembers needing to turn left, so she stopped at the light and was struck in the rear of her vehicle by Unit#1. All involved parties exchanged information and were provided the case number. Photos of the involved vehicles were uploaded to Axon. Both vehicles were safely driven off the roadway. I did not witness this collision and was unable to determine the proximate cause of the collision with the information provided. 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 M Long#12790 on 4/13/2025 @ 1413 hours in Renton WA. PAGE 3 OF 4 REPORT NO. EG20854 CASE# 25-3330 DATE AND TIME 04/13/2512:33 OF COLLISION> ' m, q�h;- 3 }4 i� v ` t a t m £j�.1� �1�1zskS1 S t t 11i t� �'a E t Sf#ttt PAGE 4 OF 4