HomeMy WebLinkAbout23-4479 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4479 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 04 - 1-- 2023 2001 17 ❑.❑ S 8 W e IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e✓ 18002 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ,❑ FEET e S ❑ W e SE 180TH ST
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2067171225 0 81
30
6� LAST NAME QASEMI FIRSTNAME QORBAN MIDDLE q
INITIAL 1 2 31
STREET ❑ 21030 109TH PL SE,APT 723 CITY KENT ST I WA 2jp, 98031 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ Pi ATES14 BYF5453 STATE WA v N# JTDKN3DU005398035
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2012 TOYT PRIUS DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO QORBAN QASEMI 21030109TH PL SE,APT 723 KENT WA 98031 D:2067171225 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 912P
VEHICLE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:2535693382
16 a
LAST NAME CONNER FIRST NAME SEAN MIDDLE T
INITIAL
17 NEW STREETREs7 12224 SE 206TH ST CITY l KENT ST WA ZIP 98031 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVEW # STATE WA SEX U MMDDYY 01 21 1986 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BIF0879 TATE 41
WA VIN# KMHC75LC3HU055232 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
GI
VEH YEAR 2017 MAKE yyU/I/ MODEL /ON/(,� STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO USAA 02365 10 52GIN 1 9TOP
VE."Le CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES Ncl
❑ J s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.S/MS 12225 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED55841
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4479
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.
E.SIMS 04-21-2312:10AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
G.BARFIELD 6476 413012023 4:36:27 PM
BADGE OR ID# 12225 OR]# WA0171300 TIME POLICE DISPATCHED 8:10 PM TIME POLICE ARRIVED]8:16 PM
PART I PAGE IT]OF 4�
REPORT NO. ED55841 CASE# 23-4479 OF COLLISION
04/20/23 20:01
OF CbLLI510N
NARRATIVE
RPD CASE#: 23-4479
On 04/20/2023 at approximately 2010 hours, I was dispatched to SE 180th ST and 108th Ave SE, in
the City of Renton, King County, Washington, for a non-injury, non-blocking accident.
Upon arrival I identified Unit 1 as a black 2012 Toyota Prius, bearing WA license plate #BYF5453.
Unit 1 sustained minor damage to the front bumper. Unit 2 was identified as a 2017 Hyundai loniq,
bearing WA license plate #BIF0879. Unit 2 sustained minor damage to the rear bumper of the
vehicle.
I identified the driver of Unit 1 via his WADL as Qorban Ali Qasemi (DOB 08/29/1995). Qasemi stated
he was not injured, and I asked him what happened. Qasemi told me he was driving southbound in
the number one lane, in the 18000 block of 108th Ave SE, approaching the intersection of SE 180th
ST and 108th Ave SE. Qasemi stated the traffic light was green when he approached the rear of Unit
2 who was in front of him. Qasemi stated Unit 2 was not moving and he hit the rear of it. When I
asked why he hit the rear of Unit 2 he could not give me an answer. I asked if he was not paying
attention and he initially stated yes and then stated he did not know.
I identified the driver of Unit 2 via his WADL as Sean TJ Conner (DOB 01/21/1986). Conner stated he
was not injured, and I asked him what happened. Conner stated he was stopped at a red traffic light
facing southbound in the number one lane, at the intersection of SE 180th ST and 108th Ave SE,
when he was hit from behind by Unit 1.
I asked to see both parties, license, registration and proof of insurance. Qasemi told me he was
borrowing the car and did not have the insurance for it. Qasemi told me his friend was bringing the
insurance card to him and he would arrive within minutes. The friend arrived and provided me with an
expired insurance card. I told Qasemi that as the driver he was responsible for having valid insurance
with him when operating the motor vehicle. I told Qasemi that he was the at fault driver and he would
receive a citation in the male for inattentive driving and for operating a motor vehicle without
insurance.
I provided both parties with an information exchange sheet, answered their questions and cleared the
scene.
This ends my report.
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 E. Sims on 04/20/2023 at 2354 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. ED55841 CASE# 23-4479 DATE AND TIME 04/20/23 20:01
OF COLLISION
UNIT 1
UNIT
NOT TO SCALE
Cn
w
SE 180th ST
00
PAGE 4 OF 4