HomeMy WebLinkAbout26-2655 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 26-2655 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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'. O4 - 1-— 2O2G 1204 17 ❑-❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 2 29
UNIT 01 MOTOR CYCLE
❑ YES ]NO
MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9❑ P1 AT 14 CLS1535 STATE WA VIN# 3FAHP08146R180464
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 2006 FORD FUSION DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO LORENA FERNANDEZ BEJINE-7 11612108TH STREET CT E BONNEY LAKE WA 98391 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VEwcte 1 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:6023179783
16 a
LAST NAME NAEF 77771 FIRST NAME KHALID MIDDLE F
INITIAL
17 STREET I❑ 19438 134TH AVE SE CITY RENTON ST WA ZIP 98058 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LDIIVEW # STATE WA SEX M M .C.B. O6 _ 16 _ 1968 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
LICENSE ❑21❑ PLA E# CTZ3681 TATe 41
WA VIN1i KM8SSDA19M0002929 4
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE HYUN MODEL SANTA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO PRIVATE YES NO
REGISTERED OWNER INFO MARYAMFAHAD19438134THAVESERENTONWA98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO GEICO 6185237804IN 1U�'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG92621
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2655
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.ARNOLD 04-06-26 01:39 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/7/2026 3:49:12 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED; 12:41 PM TIME POLICE ARRIVED',12:41 PM
PART I PAGE IT]OF 4�
REPORT NO. EG92621 CASE# 26-2655 OF COLLISION
04/06/26 12:04
OF CbLLI510N
NARRATIVE
CC 26-2655
On 4/6/2026 at 1241 hours I was dispatched to a hit and run collision at 1300 block of SW 43rd St in
the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling West on SW 43rd St at around the 1300 block in the #2 lane.
Collision
Driver 2 stated that Unit 1 was behind him and stated that Unit 1 proceeded to pass him on his left in
the 2 way center turn lane. Upon doing this, Driver 2 stated that the passenger side of Unit 1 collided
with and scraped alongside the entirety of the drivers side of Unit 2.
Driver 2 took photos of the other involved driver which were uploaded along with this case. Driver 2
stated that he does not wish to pursue charges at this time for the crime of hit and run.
Driver 2 stated that Driver 1 fled the scene Westbound.
Injuries
None reported.
Vehicle Disposition
Unit 2 was privately towed from the scene due to damage.
Proximate Cause
This report is for insurance purposes as Driver 2 does not wish to pursue criminal charges at this
time.
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 Officer C. Arnold #12509 at 13:13 on 4/6/2026 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG92621 CASE# ' 26-2655 DATE AND TIME 04/06/26 12:04
OF COLLISION
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