HomeMy WebLinkAbout25-9136 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EG44862
COLLISION REPRT 1591971
CASE# 25-9136 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL AGENC'Y 4200 3
COUNTY RD NVOLVED 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
coulsloN' 10 - 22 - 2025 0812 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 5TH ST BLOCK NO. e 4300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
2 0 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:2065828818 Q 1 30
5 LAST NAME FORD FIRST NAME JALAIA MIDDLE A 1 1 2 31
INITIAL
STREET 600 SW 5TH CT APT K308 CITY RENTON ST WA ZIP 980575873 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCK YEs NO YES NO
8 LICIENS# STATE WA SEX F MMo YY' 02 - 05 - 2004 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CJR0525 STATE WA VN# 3VWC57BU8MM090117 3
10[9� PI ATF#
11[—j— TRAILER STATE TRAILER ,STATE ROM TO
11 2 5 PLATE# PLATE#
TRLR TRLR 3 7 33
12 2 5 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 2021 VOLK JETTA DAMAGE YES DNO ✓ YEs_ No 3 7 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO DIRECT AUTO INSURANCE 2023438897 3 4
IN EFFECT &POLICY#VEHICLE 4TOP _
srgNOLNG 5A0625804 CHARGE IMPROPER LANE USAGE o ooTro6 36
Yes NO CITATION#
15
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2067427857
16�
LAST NAME MOHAMMED FIRST NAME SALA MIDDLE'
INITIAL
STREET ❑ 37
17 ' 10531 STONE AVE N APT 103 CITY SEATTLE ST, WA ZIP 981338963
NEW ADDRESS
1$ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANS}ORTED' 38
INTERLOCKYEs No INTERLOCK YES 0-01 ES NOi
19 DRIVER'S STATE WA SEX M D.O.B. 01 13 1990 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE CLY4704 TATE WA vIN# JTDKN3DU9A0199432 41
22❑ PLATE# STATE PAAILER
TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q1Q MAKE TOYT MODEL PRIUS STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE DAGAREA
LIABILITY INSURANCE INSURANCE CO THE GENERAL WA7993490
IN EFFECT &POLICY# I STOP 5
veeiae ❑ ,J—I CITATION# CHARGE t080TTOM
LecnLLY YES N`.LJ
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG44862
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9136
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.ARNOLD 10-22-25 09:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 11/4/2025 12:03:03 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 8:18 AM TIME POLICE ARRIVED 8:38 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT No.` EG44862 CASE# 25-9136 O COLLI COLLISION TIME
OF 10/22/25 08:12
COLLI
NARRATIVE
CC 25-9136
On 10/22/2025 at 0818 hours I was dispatched to a motor vehicle collision at around the 4300 block
of NE 5th St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling West on NE 5th St in the #1 lane approaching the 4300 block.
Driver 1 stated that she was parked on the North side of NE 5th St at around the 4300 block facing
West and was preparing to merge into traffic to proceed West.
Collision
Driver 2 stated that as he passed Unit 1, Unit 1 merged from the side of the roadway and the front
drivers side bumper collided with Unit 2 as it passed by, causing a scrape down the passenger side
doors and quarter panels of Unit 2.
Driver 1 stated that she merged from the side of the roadway and the front drivers side bumper
collided with Unit 2 as it passed by, causing a scrape down the passenger side doors and quarter
panels of Unit 2.
Injuries
None reported
Vehicle Disposition
Both vehicles were operational
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited per RCW 46.61.140.
1 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 C. Arnold #12509 at 09:12 on 10/22/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG44862 CASE# 25-9136 DATE AND TIME i 10/22/25 08:12
OF COLLISION
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