HomeMy WebLinkAbout24-1223 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-1223 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&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#
COLLISION'. O2 - 1-- 2024 1604 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e S 3RD PL
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4256389548 0 81
30
6� LAST NAME HASAAN FIRSTNAME NAZMAH MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 9322 7TH AVE S CITY SEATTLE ST WA Zjp, 98108 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# AXP8973 sTAr WAu N# 1 HGCR2F33DA086390
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 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 3 2013 HOND ACC LX DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO FARHAN MOHAMED17305121STLN SEAPTW201 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VErIICLE 5 36
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LEGALLY STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063595581
16 a
LAST NAME NGUYEN FIRST NAME VAN MIDDLE M
INITIAL
17❑ STREET ❑', 7618 40TH AVE S APT 106 CITY' SEATTLE ST WA ZIP 981183755 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I No� YES t l NO❑
19 LICENSE# STATE WA SEX M M .C.B. 08 _ 11 1993 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIEs ❑ 40
USE CLASS UNK
21❑ LICENSE BZR1671 TArE WA vIN1i JTEBU5JR1E5182403
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE TOYT MODEL 4RUNNER STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO RENA ESPIRITU 761840TH AVE SAPT f06 SEATTLE WA 98118 VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. I GD
VE""LE CITATION# CHARGE
LEGALLY YES Nu
25❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE50259
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1223
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NGUYEN M/NH H
(LAST FIRST,
ADDRESS&PHONE#
7618 40TH AVE S APT 106 SEATTlE WA 981183755 SEXi F MMDOYyry 05 - 25 - 1965
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS[]
i UNIT# 2 POS 8 AIRBAG 2 RESTR. 4 EJECT I USE CLASS 7 uNK
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
M.LEVERTON 02-06-24 10:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 2/14/2024 10:46:19 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 4:05 pry] TIME POLICE ARRIVED',4:08 pry
PART I PAGE IT]OF 4�
REPORT NO. EE50259 CASE# 24-1223 OF COLLISION
02/02/24 16:04
OF CbLLI510N
NARRATIVE
wht suv lane 3 stop slv sedan rear
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at Rainier Ave S at S
3rd PI.
Both drivers were able to move their vehicles to a nearby parking lot. Unit 2 requested Renton Fire
respond.
I contacted the driver of unit 2 who told me he was stopped northbound lane 3 Rainier Ave S when he
was contacted by unit 2. He didnt complain of any specific injury. He was checked and released on
scene. Damages to his vehicle were minor. Unit 2 told me that a car had cut in front of him and he
braked to avoid that car, but was contacted by unit 2.
1 contacted the driver of unit 1 who told me she thought traffic was moving, however, unit 1 was cut off
and she had to emergency brake to avoid his emergency braking and made contact with the back of
his vehicle. It bent his receiver stop. She did not complain of injury and damages were minor that did
not require a tow truck.
Information/Insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 2/6/2024
PAGE 3 OF 4
REPORT NO. EE50259 CASE# ' 24-1223 DATE AND TIME 02/02/24 16:04
OF COLLISION
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PAGE 4 OF 4