HomeMy WebLinkAbout25-7736 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-7736 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 09 - 1-- 2025 0924 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW LANGSTON RD BLOCK NO. e✓ g00 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e THOMAS AVE SW
0 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:9144500886 0 4 30
6� LAST NAME GOLDBERG FIRSTNAME ROBIN MIDDLE S 1 1 2 31
INITIAL
STREET ❑, 15212 NE 8TH ST APT F8 CITY BELLEVUE ST WA Zjp, 980074848 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YEs No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BXE4018 sTArI WAurN# JF2GFHSC9MH270459
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH. 2021 YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 5 34
13 4 SUBA CROSST DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ROBIN GOLDBERG 15212 NE 8TH STAPT F8 BELLEVUE WA 98007 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE NSURANCECOAMERICAN FAMILY 410911275478
IN EFFECT &POLICY# 9TOP
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:4255245390
16 a
LAST NAME AHMED FIRST NAME JABBIR MIDDLE R
INITIAL
17❑ STREET ❑', 402 S 33RD PL CITY' RENTON ST WA ZIP 980555012 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVEW # STATE WA SEX M M .C.B. 11 02 _ 2002 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE 3332133 TArE 41
GOV vIN1 W1X406EM2P4235340
❑
pLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE MERZ MODEL METRIS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YESfj
NO,/ YES NO
REGISTERED OWNER INFO UNITED STATES POSTAL SERVICE 314 WILLIAMS AVE S RENTON WA 98057 D:4255245390 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO TORT CLAIM INSURANCE USPS STOP 5
IN EFFECT
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EG36325
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7736
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
25-7736 ACC
On 9/5/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two-vehicle non-injury collision in the intersection of
SW Langston Rd and Thomas Ave SW Renton/King/WA. No injuries were reported but it was
blocking.
I arrived on scene and located both involved parties, they advised they were no injured.
The driver of the 2021 Subaru Crosstrek WA/BXE4018 was identified by her WADL as Robin S
Goldberg DOB: 5/15/1982. Robin said that she was driving west on SW Langston Rd, she said that
the LISPS vehicle was in front of her and made a sudden left turn as she went to drive around it.
There was no airbag deployment and there was damage down the passenger side of the Subaru.
The driver of the 2023 Mecedes Metris GOV/3332133 was identified by his WADL as Jabbir R Ahmed
DOB: 11/2/2002. Jabbir said that he was preparing to turn left onto Thomas Ave SW from SW
Langston when the Subaru came up behind him and hit him. The front bumper had been ripped off
the front of the Mercedes. There was no airbag deployment, and the Mercedes was able to move out
of the roadway and wait for a private tow.
The Crosstrek was able to leave the scene.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 9/5/2025 Renton WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 09-05-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 1 1011012025 1:30:01 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 9:35 AM TIME POLICE ARRIVED',9:47 AM
PART I PAGE IT]OF 3�
REPORT NO. EG36325 CASE# 25-7736 DATE AND TIME 09/05/25 09:24
OF COLLISION
�1t e 7a
iSft�
} 3 r s}
i } ✓
�}r
z
z.
t
r
3
iiy M ,
e n
PAGE 3 OF 3