HomeMy WebLinkAbout23-8614 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8614 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I 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#
cowsloN 07 - 1-- 2023 1940 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 7TH STREET BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a POWELL AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255235439 0 11
30
6� LAST NAME ALI FIRSTNAME ILHAN MIDDLE 1 2 31
INITIAL
STREET ❑, 17220 30TH AVE S APT G1 CITY SEATAC ST WA Zjp, 981883508 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'F MM DAY' 01 1- 01 - 1983 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aTES� BSF8503 sTArI WA urN# 3FAHPOHA6BR345599
TRAILER STATE TRAILER STATE
11 1 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 5 33
12 1 5 VIN#j VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /[g GOVT.VEHICLE 34
13 2011 FORD FUSION SD DAMAG 7 3 E YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO 1LHANAL1172W30THAVESAPTGI SEATACWA981883508 D:4255235439 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE Z INSURANCE CO GEICO 6109-96.72.70 4
IN EFFECT &POLICY#
ve'C 5 ❑ 36
LEGALLv res❑NO❑ CITATION# CHARGE BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5095968689
16 a
LAST NAME ROBERTS FIRST NAME MATTHIAS MIDDLE K
INITIAL
17 STREET I❑ 1065 NE ALFRED LN CITY PULLMAN ST WA ZIP 991630000 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVER #
❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BUU9234 TArE 41
WA VIN# WBAEU33484PR09513 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2004 MAKE BMW MODEL 325 STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO BROOKS ROBERTS 524322ND AVE NEAPT 2 SEATTLEWA98105 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE 8 POINSURGY#E CO STATE FARM 4761487-CO1-47
IN ll CTOP
—e E ❑ ,J� CITATION# CHARGE I BOTTOM
LEGALLY YES N 6
25 7MICAELA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 CASTAIN 7 12573 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84865
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8614
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROBERTS QUENTIN IN(LAST FIRST,
ADDRESS&PHONE# D O.B.
1065 NE ALFRED LN APT A PULLMAN WA 991634351 5095968684 SEX M MMDDYyry 12 - 13 - 1998
SEAT HELMET I INJURY NATURE OF INJURIES
PASSENGER WITNESS❑;UNIT# 2 POS 8 AIRBAG 6 RESTR, q EJECT 1 USE 2 CLASS 6 NOSE BLEED
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYVYY
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'
Unit 1: Ford Fusion (WA/BSF8503); Ilhan Ali (DOB 01/01/1983)
Unit 2: BMW (WA/BUU9234); Matthias Roberts (DOB 07/19/2001)
On 07-27-2023 at approximately 1940 hours I was dispatched to a collision with injuries at the
intersection of SW 7th Street and Powell Ave SW, in the City of Renton, King County, WA.
Upon arrival, I contacted both parties. Quentin Roberts (DOB 12/13/1998) was the front right
passenger in Unit 2. Quentin was bleeding from the nose. All parties were cleared by Renton Fire.
Both parties agreed on the collision. Unit 2 was traveling in lane 1 eastbound on SW 7th Street
through the intersection listed above. Unit 1 stopped at a stop sign north of the intersection, waiting to
travel southbound through the intersection onto Powell Ave SW. Unit 1 traveled south through the
intersection while Unit 2 was still traveling through the intersection eastbound, colliding in the middle
of the intersection. Unit 2 did not have a stop sign.
There is damage to Unit 1's front bumper and front tires. There is damage to Unit 2's front bumper
and front side doors. Both vehicles were towed to Bankers Towing Lot.
Based off the statements made above there is proximate cause for Unit 1 in the collision.
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 by Officer M. Castain #12573 7/27/2023 Renton, King County, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAELA CASTAIN 07-27-23 09:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:24:22 PM
BADGE OR ID# 12573 OR]# WA0171300 TIME POLICE DISPATCHED! 7:40 PM TIME POLICE ARRIVED';7:40 PM
PART Ei PAGE IT]OF
REPORT NO. EU84805 CASE# 23-8614 DATE AND TIME 07/27/2310:40