HomeMy WebLinkAbout22-13080 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13080 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 12 — 11 — 2022 1524 17 ❑. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252462179 0 11
30
6� LAST NAME RAPURU FIRSTNAME SUSHMA MIDDLE 1 2 31
INITIAL
STREET ❑, 6745 SE 5TH ST CITy RENTON WA
NEW ADDRESS STjP', 96059 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs 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[1P1 ATE 14 AXR8012 STATE WAa ,r,# 2T3DFREV6FW401887
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T AW/g[ GOVT.VEHICLE 34
13 2015 TOYT RAV4 HB DAMAGE YES NO � '` RS 3 7 YES[:] ✓
REGISTERED OWNER INFO NAGARAJA CHALLA 6745 SE 5TH ST RENTON WA 98059 D:4252462179 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE INSURANCE CO STATE FARM 3775821-F22.47A 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4043681737
16 a
LAST NAME CLANCEY FIRST NAME KAYLA MIDDLE A
INITIAL
17❑ NEW EET 1:❑' 433 BREMERTON AVE NE D201 CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSFORTED � 38
INTERLOCK YEs❑NO� INTERLOCK ves NoF YEs NO�
19[—] LICENSE# STATE WA SEX F M .C... 02 _ 11 1996 39
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CBM1131 TATE 41
WA YIN# 1FAHP3M22CL230157 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
TOWED BY Gov HI 44
VEH YEAR 2012 MAKE FORD MODEL FOCUS STYLE HB —TEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04568-64-46-05IN 9TOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N J
' e
7JACOB
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26WEBER 12532 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED13821
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13080
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RAPURU N/THYA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
6745 SE 5TH ST RENTON WA 98059 4256631198 SEXi F MMDDYyry 12 - 07 - 2007
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. 7 2 4 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) PADMA JALAJA
ADDRESS&PHONE# D O B
RENTON 4255235564 SEXI F MMDDYVYv 12 _ 13 _ 1984
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 1 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On December 12th, 2022, at approximately 1525 hours I was dispatched to a report of a non-injury
blocking collision at the intersection of NE 4th St and Duvall Ave NE. I arrived on scene and
contacted all involved parties who advised they were ok. Fire was called as a precaution due to
Vehicle 2 having airbag deployment. Driver 1 stated she was traveling eastbound on NE 4th St when
she attempted to make a left hand turn northbound onto Duvall Ave NE on a blinking yellow arrow
when she was struck by Vehicle 2 in the middle of the intersection. Driver 2 stated she was traveling
westbound on NE 4th St on a green light when Vehicle 1 turned in front of her. Driver 2 was unable to
stop in time to avoid the collision. Driver 1 advised she never saw Vehicle 2 prior to making her turn.
Both vehicles were towed by Bankers. All involved parties were cleared by fire.
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 05:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 1211212022 4:29:09 PM
BADGE OR ID# 12532 OR]# WA0171300 TIME POLICE DISPATCHED 3:25 PM TIME POLICE ARRIVED'3:33 PM
PART I PAGE 2�OF❑
REPORT NO.! ED13821 CASE# ' 22-13080 DATE AND TIME 12/11/22 15:24
OF COLLISION
Duvall Ave NE
N
NE 4th St
138th Ave SE
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