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Home My WebLink About22-13071 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 22-13071 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ H F ❑ LOCAL AOENC 3 HIT IT&8 RUN � CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ C{YLLISION 1Q - 11 - 2022 0958 17 ❑.� S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SUNNET BLVD N BLOCK NO. e✓ 300 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 20 00 FEET MILES e S B W e N 3RD ST 0 1 29 UNIT MOTOR Z PEDAL- CYCLE El DAYESMAGE NHORESHOLD MET PHONE 01 0 81 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY RENTON ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES 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 LICENSE STATE VIN#' 10 2❑ Pr ATF� TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM ro rRLR. TRLR. 1 5 33 12 3 5 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R 9 34 13 3 NISS UNKNO SD DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LABILI INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEwcLE CHARGE 5 36 LECALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4253996068 16 a LAST NAME AHMADI FIRST NAME CLAREASE MIDDLE J INITIAL 17❑ STREET ADOREsS❑' 1150 SUNSET BLVD NE APT 112 CITY RENTON ST WA ZIP 98056 37 ❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YES❑NoF,/l I INTERLOCK YES❑NoF YES❑NO 19 D IVEW # ❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑ILICENSE 21❑ PLA E# AKY4415 TATE WA VIN# 1(B1ZE5E01 CF198662 41 4 42 22 [TRAILER TILER ❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2012 MAKE CHEV MODEL MALIBU STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO ALEXANDER AHMADI 1150 SUNSET BLVD NE APT 112 RENTON WA 98056 D:4253993508 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU PORGY#E CO GEICO 6116852895IN I 9TOP —e E ES[Z N CITATION# CHARGE � i o BOTTOM LEGALLY Y 25❑ [AGENCY s 7JAWEBER NAME(PRINT) OFFICER PHONE BADGE OR ID# 26 12532 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED13817 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13071 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) AHMADI ALEXANDER B (I.P.ST FIRST, ADDRESS&PHONE# D O.B. 1150 SUNSET BLVD NE APT 112 RENTON WA 98065 4253993508 SEX M MMDDYyvv 10 - 03 - 1985 PASSENGER I�I WITNESS UNIT I 2 POS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET 2 ICLAS� 1 NATURE of INJURIES NAME L�1 (LAST,FIRST,MIDDLE INITIAL) VU TUYET H ADDRESS&PHONE# D O B 620 BLAINE CT NE RENTON WA 98056 2064582611 SEX M MMDDYvvv 11 _ 24 _ 1948 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 3 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) PATTEN ROBERT H ADDRESS PHONE# 1028 73RD DR SE LAKE STEVENS WA 98358 2067782989 SEX M M _ D.O.B. 11 18 _ 1980 MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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. JACOB WEBER 12-11-22 11:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 1211212022 4:29:05 PM BADGE OR ID# 12532 OR]# WA0171300 TIME POLICE DISPATCHED; 9:89 AM TIME POLICE ARRIVED',10:01 AM PART Ei PAGE IT]OF TIME REPORT NO. ED13817 CASE# 22-13071 OF COLLISION12/11/22 09:58 NARRATIVE On December 11 th, 2022, at approximately 0959 hours I was dispatched to a report of an injury vehicle collision which occurred at the intersection and NE 3rd St and Sunset Blvd N. Dispatch advised one of the parties was complaining of back pain. I arrived on scene and spoke to the driver and passenger of Vehicle 3 who advised they were ok. Ofc. Castain spoke with the driver and passenger of Vehicle 2 who both advised their backs hurt. Renton Fire arrived and determined there was no need to transport any of the involved parties for medical treatment. Driver 2 stated she had been traveling south on Sunset Blvd N when she stopped at the stoplight at NE 3rd St. Seconds after stopping, she was struck in the rear of her car by Vehicle 3, who had been struck in the rear by Vehicle 1. Driver 2 did not see Vehicle 1, nor the driver of Vehicle 1. Driver 3 stated he was traveling south on Sunset Blvd N when he stopped behind Vehicle 2 for the stoplight at NE 3rd St. Shortly after Driver 3 stopped, he advised he was struck in the rear of his car by Vehicle 1, causing him to slide forward into the rear of Vehicle 2. According to Robert H Patten, a witness to the collision, Vehicle 1, a red Nissan Altima or Maxima with a plate he believed to be WA LIC: CMB5808 (Returned as a bad plate/ no record) had failed to slow for stopping traffic causing it to strike Vehicle 3. Upon striking Vehicle 3, Vehicle 1 backed up and fled from the scene westbound on NE 3rd St. Robert was unable to describe the driver. A check of the area returned negative. There was very minor damage to Vehicle 2 and 3, unknown damage to Vehicle 1. No airbag deployment, all parties were utilizing seatbelts. Neither vehicle 2 or 3 were towed. The occupants of Vehicle 2 advised they would be enroute to Urgent care to be evaluated. Forwarding to Traffic for review. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED13817 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 22-13071 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:2054858261 ] OF 8 29 LAST NAME :. BUI FIRST NAME TORN MIDDLE ,.. K r:j INITIAL STREET 30 NFW AnDRFSP' 620 BLAINE CT NE CITY RENTON ST WA ZIP 98056 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO✓ NTERLOCK YEs�NO� YEs N ✓ DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 03 - 09 - 1947 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE ABV9152 [TAT WA VIN# 1HGCM56303A142414 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE If STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2003 MAKE HOND MODELACCORD STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1I' P FROM TO DAMAGE YES NO ✓ YES NO ✓ REGISTERED OWNER INFO OWNED BY DRIVER J 9 33 12 � SHADE IN DAMAGED AREA j FROM TO LIABILITY INSURANCE INSURANCE CO STATE FARM 3874995-F21-47A q"i"Olx IN EFFECT &POLICY# VEHICLE 10 6QTTUM 34 3 CITATION# CHARGE 13 LEG LEY YES NO gg�@ STANDING �}✓ l:9 7 14 ❑ UNIT Tr MOTOR d 1 RE O CYCLE PROPERT � DASMMNOHRESHOLDMET PHONE ❑ 35 PEDESTRIAN YE 15 LAST NAME FIRST NAME INITIAL 36 MIDDLE ❑ STREET"[-] 16 NFW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE If STATE 21 ❑ ❑ 41 TRLR TRLR ViN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LeGALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JACOB WEBER 12-11-22 11:20 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12532 O#I',WA0171300 APPROVED BY 12112/202 PAGE F OF 5 3000-345-013(R 11118) REPORT NO.! ED13817 CASE# ' 22-13071 DATE AND TIME 12/11/22 09:58 OF COLLISION Z W in Arlik K u" N3ST PAGE 5 OF 5