HomeMy WebLinkAbout23-8405 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8405 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cawsloN 07 - 1-- 2023 1802 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
FIELD AVE NE BLOCK NO. e✓ 1900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 19TH ST
0 4 29
UNIT MOTOR
VEHICL PI CYCLE
ElDDAMYESA✓THRESHOLD PHONE 0 11
30
6� LAST NAME HERNANDEZ FIRSTNAME ADRIAN MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 4904 NE 19TH CT CITY RENTON ST WA ZIP 980594271 z
NEW ADDRESS
7❑ 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 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BUB6651 sTArI WAVrN# WBANE53506CK79949
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 1 $TOWED BY GOVT.VEHICLE 34
13 4 BMW 525 SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO .GONZALEZMARTINEZ4904 NE 19TH CT RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2006971347 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER [:]EA.
YES 1/ NO D:2067471917
16 a
LAST NAME SHEIKH FIRST NAME MOHAMMED MIDDLE I S
INITIAL
17 STREET NEW ADORE87 5116 NE 19TH ST CITY RENTON ST WA ZIP 980594257 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO INTERLOCK YEs It I NOF YES
t l NOF,/
19 D STATEWASEXM .CB. _ _ 39
# M .
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLATE# BIH2137 TArE WA VIN1i KNALN4D78F5170936 41
1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE KIA MODEL CADENZ STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SAID SHEIKH 5116 NE 19TH ST RENTON WA 98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU8 PORGY#E CO TRAVELERS INSURANCE 6049196312031 STOP 5
IN EFFECT
VE""LE ❑ ,J CITATION# CHARGE io BOTTOM
LEGALLY YES Nu
25 ' a
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84862
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8405
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
POS. 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'
23-8405
On July 22, 2023 at 1802 hours dispatch requested that I respond to a collision at Field Ave NE and
NE 19th St, in the City of Renton, County of King, and State of Washington. The reporting party
stated they were involved in a collision and one of the vehicle's was leaking radiator fluid.
Upon contact, I spoke with the driver of unit 1, a BMW 525 bearing Washington plates BUB6651. The
driver, Adrian Hernandez (09/05/2003), explained he was driving northbound on Field Ave NE when
the collision occurred. He made a left turn on NE 19th St but failed to notice unit 2 driving
southbound. His vehicle drove head on, causing major damage to both vehicles.
I then spoke with the driver of unit 2, Kia Cadenza bearing Washington plates BIH2137. The driver,
Mohammed S. Sheikh (05/06/2002), said he was driving southbound on Field Ave NE when unit 1
drove head on into his vehicle.
Mohammed believes Adrian was attempting to make a left turn onto NE 19th St.
Both vehicles were severely damaged, but unit 1 was still drivable. Unit 2 was towed away by Gene
Meyers Towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 07-22-23 07:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 713112023 6:24:33 PM
BADGE OR ID# 12007 ORI#' WA0171300 TIME POLICE DISPATCHED 6:10 PM TIME POLICE ARRIVED';6:15 PM
PART I PAGE IT]OF
REPORT NO. ED84862 CASE# ' 23-8405 DATE AND TIME 07/22/23 18:02
OF COLLISION
71
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CIE 19TH ST
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