HomeMy WebLinkAbout25-9273 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-9273 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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.. 10 - 1-- 2025 1555 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N SOUTHPORT DR BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e GARDEN AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064998204 0 81
30
6❑ LAST NAME RASOOLI FIRSTNAME SAVED MIDDLE J 1 1 2 31
INITIAL
STREET ❑✓ 2955 NE 11TH ST CITY RENTON ST WA ZIP 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 07 1- 24 - 2007 2 32
9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 3 EJECT 1 I I [NATURE OF
H U EET 2 1 INJURY CLASS ju CUT ON HAND INJURIES z❑
3
LICENSE CTA9675 STATE WA VIN#
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE
T COROL SD TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2015 TOYT COROL SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFOSAYEDRASOOL12955 NE 11THST RENTON WA 98056 D:2064998204 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14� INEFITYINSURANCEz &POLICY# ALLSTATE820969812 4
LI EFFECT I POLICY# TOPVENICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ cvcLE ❑ ❑ OWNER YES No %/ RO 2064657435
16 a
LAST NAME BREWER FIRST NAME JEFFREY MIDDLE L
INITIAL
17 STREET ITMAN AVE NE CITY SHORELINE ST WA ZIP 98133 4❑ 37
NEW ADOREs�' 20300 WHI
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INERLOCKYES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 3 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLATE# A7861C TATE 41
WA VIN# 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE NEW MODEL BUS STYLE BU VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JEFFREY BREWER 20300 WHITMAN AVE NE SHORELINE WA 98133 D:2064657435 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE❑ 8 POLICY#E CO UNKNOWNIN 1 STOP
vE""LE CITATION# CHARGE
YES
25 N i o BOTTOM
LEGALLY u
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.EDWARDS 9070 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG58879
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9273
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RASOOLI SHAFIQULLAH
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2955 NE 11TH ST RENTON WA 98056 SEX M MMDOYyry 12 - 20 - 2012
PASSENGER ZWITNESS SEAT HELMET INJURY NATURE OF INJURIES
� UNIT POS. 8 AIRBAG 3 RESTR. 3 EJECT USE 2 CLASS I6 SCRATCHONLEG
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYV
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.EDWARDS 10-27-25 12:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 12/15/2025 8:44:07 AM
BADGE OR ID# 9070 OR]# WA0171300 TIME POLICE DISPATCHED 3:57 PM TIME POLICE ARRIVED',4:02 PM
PART I PAGE IT]OF 4]
REPORT NO. EG58879 CASE# 25-9273 OF COLLISION
1 0/26125 1 5:55
OF CbLLI510N
NARRATIVE
Assignment:
On 10/26/2025, 1 was working uniformed patrol in a marked Renton PD unit. I was assigned to district
22. At approximately 1600 hours I was dispatched to a collision report at N Southport Dr/Garden Ave
N, city of Renton, King County, WA.
Call notes stated:
"VEH VS BUS...1 SUBJ UNCONSC... LINK IF BREATHING NORMALLY..."
While enroute, dispatch provided the additional updates:
`*CORR SUBJ IS AIRBGAS DEPLOYED...TOYT DRIVER IS CONS, LAC TO HAND..."
On arrival, I observed Unit 1, a light blue Toyota Corolla (WA/CTA9675) in the right westbound lane.
Unit 1 had front end damage and was resting on the rear bumper of Unit 2, a green King County
Metro Bus (WA/A7861 C).
Unit 1's front airbags were deployed, and the front-end damage appeared to meet the damage
threshold. Unit 2 appeared to have minor damage not meeting the threshold.
Driver 1 stated he was travelling westbound on N Southport Dr when he observed traffic in front of
him slowing. Driver 1 put his foot on the brakes to come to a stop. Unit 1 slid and continued
westbound, colliding with the back of Unit 2. Driver 1 had a small laceration on his left hand. He was
evaluated by Renton Fire at the scene.
Passenger 1 was sitting in the front passenger seat of Unit 1. Passenger 1 stated Driver 1 had braked
for slowing traffic and Unit 1 slid before contacting Unit 2. Passenger 1 had a small scratch on his left
leg. He was evaluated by Renton Fire at the scene.
Driver 2 was stopped at the red light facing westbound on N Southport Dr at the intersection of
Garden Ave N. Driver 2 felt a bump at the rear of Unit 2 and realized Unit 1 had collided with him.
Driver 2 was uninjured.
Passengers riding Unit 2 left the area. Nobody reported any injuries or requested assistance.
Photos of the damaged vehicles were taken and uploaded to Axon Evidence.
I provided both parties with the case number and a copy of the SECTOR Exchange of Information.
This concluded my involvement with the case.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
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 Z. Birkbeck/#13055 at 0049 hours on 10/27/2025, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EG58879 CASE# ' 25-9273 DATE AND TIME 10/26/25 15:55
OF COLLISION
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PAGE 4 OF 4