HomeMy WebLinkAbout25-9701 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG48302OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-9701 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCLsov' 11 - 07 - 2025 2207 17 =.= S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e 4810 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1001.1 00 FEET e✓ S 8✓ W e DUVALL AVE NE
0 4 29
MOTOR PEDAL- DAMAG THRESHOLD MET E
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO ✓ PHON 0 1 30
5 LAST NAME KIM FIRST NAME SAHN MIDDLE 1 2 31
INITIAL
STREET ❑ 4426 NE 17TH ST CITY; RENTON ST WA ZIP; 980593927 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO✓ INTERLOCKVES NO✓ YES NO;✓
8 DRIVER' # STATE WA SEX I M MM0,13. 10 — 28 — 2001 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 JHELM
USEET 2 CLASSY 1 NATURE of INJURIES 2
LICENSE, CET3445 STATE WA VIN#; 1HGCT2B83EA007627 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR TRLR 7 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZOI4 MAKE yOND MODEL ACCOR 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 GINA LEE 4426 NE 17TH ST RENTON WA 980593927 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2
14 ✓ GE/CO 4229-67-80-26
IN EFFECT &POLICY# i STOP _ 5
VEHICLE CHARGE 7 o QOTTOM 36
Lemur YES❑NO❑ CITATION# 5
15❑ sTnNowc s 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2064077262
16�
LAST NAME GEBREEGZIABHER FIRST NAME MENBERE MIDDLE'
INITIAL
17 F1 STREET ❑ 465 QUEEN AVE NE APT 401 CITY RENTON ST, WA ZIP 980567404 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYES NO✓ INTERLO"K YES NO✓ YEs NO'✓
19 DRIVERS STATE WA SEXI F I D.Oa I 10 I— 25 1978 � 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 I LICENSEEJECT 1 1HELM
USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 PLATE# BXV9585 rare WA vIN# WA1 G2AFY9M2045714 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2021 MAKE gUDI MODEL Q5 STYLE p4 VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO AMAHAMESHESHA 465 QUEEN AVE NE APT 401 RENTON WA 980567404 D:2064077262 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO ALLSTATE 969425032
IN EFFECT &POLICY# 9TOP
VeEIL ,J—I CITATION# CHARGE t080TTOM
LEn��Y YES❑ N`[
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MARIA FERNANDES 12848 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG48302
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9701
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
: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
The driver of Vehicle 1 was driving eastbound in the 4800 block of NE 4TH ST where he stopped to
make a left (northbound) turn into the parking lot of 4810 NE 4TH ST. Driver 1 said that a vehicle
heading westbound on NE 4TH (in the south lane) stopped to allow him to make his left turn. That
vehicle was blocking driver 1's view of the other westbound (northern) lane. Driver 1 completed his
left turn and as he was entering the parking lot, Vehicle 2 hit the right rear quarter panel with their
front bumper. Driver 2 said she was driving westbound in the northern lane of NE 4TH ST in the 4800
block when Vehicle 1 turned left in front of her. She did not see Vehicle 1 turning and struck the
vehicle with her front bumper. There were no injuries. The collision caused minor damage to the front
bumper of Vehicle 2 and the right rear quarter panel of Vehicle 1. 1 took photographs of the damage
and completed an exhange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MARIA FERNANDES 11-07-25 11:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1111312025 11:47:22 PM
BADGE OR ID# 12848 ORI# WA0171300 TIME POLICE DISPATCHED 10:12 PM TIME POLICE ARRIVED i 10:17 PM
PAST B a Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG48302 CASE# 25-9701 DATE AND TIME 11/07/25 22:07
OF COLLISION
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