HomeMy WebLinkAbout25-8228 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-8228 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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#
COLLISION' 09 - 1-- 2025 1220 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 2ND ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e W/L!IAMS AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066377419 0 11
30
6� LAST NAME AHMED FIRSTNAME AMINA MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 329 S 177TH PL#E204 CITY SEATTLE ST WA ZIP 98148 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BTF4509 sTATI WA vIN# 5YFEPRAE9LP004865
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 2 5 VIN# VIN#
FROM TO
❑ VEH.YEAR I MAKE I MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2020 TOYT COROL SD DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO gMINA AHMED 329 S 177TH PL APT E204 SEATTLE WA 98148 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6043-75.29.37 3 4
IN EFFECT &POLICY# 9TOP
VE—LE 5 36
LEGALLY Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064608352
16 a
LAST NAME LEWIS FIRST NAME CAROLYN MIDDLE I,I
INITIAL
17❑ STREET ❑', 110 WILLIAMS AVE S UNIT 112 CITY RENTON ST WA ZIP 980575414 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX F D.C... 07 09 _ 1952 El 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CSD0080 TATe WA VIN# 2HKRW2H97LH216939
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE HOND MODEL CR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO OSCAR LEWIS 100 WILLIAMS AVE S UNIT 112 RENTON WA 98057 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04620-19-90-10IN 1GQI
vE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36336
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8228
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
PM 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'
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.
C.CATALAN 09-23-25 03:58 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1011012025 1:18:39 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; 12:22 PM TIME POLICE ARRIVED',12:22 pM
PART I PAGE IT]OF 4�
REPORT NO. EG36336 CASE# 25-8228 OF COLLISION
09/22/25 12:20
OF CbLLI510N
NARRATIVE
On September 22, 2025, at approximately 1220 hours, dispatch requested that I respond to a non-
blocking collision at the intersection of S 2nd St and Wells Ave S, within the City Limits of Renton,
County of King, State of Washington.
Upon my arrival, I confirmed there were no complaints of injury requiring immediate medical response
at the time of report. There, I was able to collect each involved party's information and independent
summary of the events leading up to the collision.
The driver of Unit#1, identified as Amina Ahmed, said she was traveling westbound on S 2nd St
approaching the intersection of Wells Ave S. Amina was in lane 2 of 2, but as she entered the
intersection, she collided with Unit#2. Amina believed Unit#2 failed to stay within her lane and
caused moderate damage to her driver's side fender.
I then spoke with the driver of Unit#2, identified as Carolyn Lewis, and she explained a similar story
as Amina. Carolyn stated she was traveling westbound on S 2nd St in land 1 of 2. Carolyn intended
on making a left turn on Wells Ave S. As she entered the intersection, both Unit#1 and Unit#2
collided in the intersection. Carolyn believes Amina made an improper lane change and struck her
vehicle. Unit#2 sustained moderate damage to the passenger side doors and fenders.
After speaking with the two drivers, I went and observed the debris left at the intersection. The debris
appeared to be in the middle of the intersection, between lane 1 and 2. Based on the statements and
road debris, I was unable to determine who committed the traffic violation. I checked with US Bank
and Sherwin-Williams to see if the properties had surveillance cameras pointed towards the roadway.
As speaking with management, US Bank stated their cameras did not reach the roadway and only
their parking lot. Sherwin-Williams management told me they would reach out if they gathered any
identifiable evidence.
This is an informational report only. Both Unit#1 and Unit#2 appeared to be drivable and an
exchange of information was provided to all involved parties.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
C. Catalan 09/23/2025 Renton
PAGE 3 OF 4
REPORT NO. EG36336 CASE# ' 25-8228 DATE AND TIME 09/22/25 12:20
OF COLLISION
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