HomeMy WebLinkAbout25-81191 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG67657OLCERA
COLLISION REPORT 1591971
CASE# 25-81191 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCCOAGENCY 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#
eaCL s o v' 12 - 31 - 2025 1806 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 4TH ST BLOCK NO. e 900 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------ 1.1 FEET e S 8 W e WELLS AVE S
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2065501598 0 1 30
6 LAST NAME ERICKSON 111 FIRST NAME DAVID MIDDLE K 1 1 2 31
INITIAL
STREET ❑ 2932 SW 337TH ST CITY; FEDERAL WAY ST WA ZIP; 98032 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES ND INTERLOCKYEs NO YES I
8 DRIVER # STATE WA SEXI M MMDDYY' 03 - 31 - 1995 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
10 2 as ENSrtEI BWG6631 STATE WA VIN# 1C4RJFAG7FC115589 3
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR zRLR. 1 1 5 33
12 0 o VIN#' VIN#
FROM TO
VEH.YEAR 201S MAKE JEEP MODEL GRAND STYLE UT VEHICLE TOWED[n TO ZBE TOWEDBY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 3 4
4 LIABILITY INSURANCE INSURANCE CO
14 Z SAPECO X6261176
IN EFFECT &POLICY#
VEHICLE CHARGE 5 36
Lemur yes❑NO❑ CITATION# OUR
15❑ sTnNowc
MOTOR PEDAL- PEDESTRIAN PROPERTY PHONE
DAM THR OLD MET N
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2066507122
16�
LAST NAME HASSAN FIRST NAME MOHAMUD MIDDLE A
INITIAL
17 F1 STREET ❑
❑ 4714 NE 2ND CT CITY RENTON ST, WA ZIP 98058 4 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGN[TION PRESENT MEDICAL TRANSPORTED: 38
INTERLOCKYES K4 INTERLt7CK YES Na YEs NO
19 DRIVER'S STATE WA SEXM I D.O.B. 01 01 1971 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJUI Y 1 NATURE OF INJURIES 40
CLASS
21 LICENSE CPW6624 TATE WA SIN JTDKARFUBL3115632 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE TOYT MODEL PR/US STYLE /-IB VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO NO
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
NQ.2
SHADE IN DAGEAREA
2
LIABILITY INSURANCE INSURANCE CO GIECO4465395368
IN EFFECT &POLICY# 9TOP
HICLE EEILe L YES❑ NJ—I, CITATION11 CHARGE to BOTTOM
VE
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG67657
COLLISION REPORT III III III III III 111
1591972 CASE# 25-81191
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 INJURY 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
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.
KEITH PETTY 12-31-25 07:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 111012026 2:02:42 PM
BADGE OR ID# 12809 ORI#s WA0171300 TIME POLICE DISPATCHED 6:06 PM TIME POLICE ARRIVED i 6:06 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 57
REPORT NO. EG67657 CASE# 25-81191 O OF COLLISION TIME 12/31/25 18:06
NARRATIVE
25-81191
On 12/31/2025 at approximately 1806 hours, I was dispatched to the intersection of S 4th ST and
Wells Ave S in the City of Renton, County of King, State of Washington for 2 vehicle collision with no
injuries.
Upon arrival I confirmed there were no injuries and determined the following:
Unit 1 was gray 2015 Jeep Grand Cherokee (BWG6631/WA) VIN/1C4RJFAG7FC115589 driven by
the registered owner, David Kenneth Erickson (DOB 03/31/1995) identified by is WADL.
Unit 2 was a black 2020 Toyota Prius (CPW6624/WA) VIN/JTDKARFU8L3115632 driven by the
registered owner Mohamud Abdi Hassan (DOB 01/01/1971) identified by his WADL.
Unit 1 stated he was stopped at the intersection heading south. He did not see anyone proceeding
through the intersection and he went. As he began into the intersection he turned his radio down,
when he looked back he collided with unit 2.
Unit 2 stated that he was heading west on S 4th St. He waited for a vehicle that was Infront of unit 1
to proceed through the intersection then he went. As he crossed over unit 1 collided into the
passenger side doors. The damage was estimated over $1000.
I provided an exchange of information to both parties.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 12/31/25at 1915 hours, Place: Renton, King County, WA
PAGE 3 OF 5
REPORT NO. EG67657 CASE# 25-81191 O OF COLLISION TIME 12/31/25 18:06
NARRATIVE
PAGE 4 OF 5
REPORT NO. EG67657 CASE# 25-81191 DATE AND TIME 12/31/2518:06
OF COLLISION
va
++
a¢
fr
,
0
ly � y5 s
� l
y
V
y
R i c
v„r+
s.ti
4
y
y
PAGE 5 OF 5