HomeMy WebLinkAbout23-4821 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4821 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#
cowsloN 04 - 1-- 2023 1115 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NILE AVE NE BLOCK NO. e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 6TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:5103967594 0 11
30
6� LAST NAME THOMAS FIRSTNAME SHILPA MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 27444 212TH PL SE CITY MAPLE VALLEY ST WA ZIP 98038 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE BSZ7482 sTATe WA urN#' 5J6RW2H51KA019083
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 5 1 34
13 2 2019 HOND CR-V UT DAMAGE vEs 0NO agW�MEYERS ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO CONNECT SX12458533 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 3AO344354 FAIL YIELD AT YIELD 1 o Borrow
15❑ MOTOR STANDING
- PROPERTY THR OLD MET PHONE
UN�T 0' ❑✓ PEDAL ❑ :PEDESTRIAN ❑ ❑ DAM�/ NO D:2065516200
VEHICLE CYCLE : OWNER
YES
16 a
LAST NAME SINGH FIRST NAME MANXT MIDDLE
INITIAL
17❑ NEW STREETR 16020 S
7 E 144TH ST CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK vEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M M D.C.B. 01 18 _ 1972 39
H USE ET INJURY 6 ABRASIONS FROM AIRBAGS ❑F—NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1
LICENSE I ❑21❑ PLA E# CAR0170 TATe 41
WA VIN# SYJYGDEEXMF261279 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2021 MAKE TESL MODEL MODEL Y STYLE SO DAMAGE TOWED✓ NOO BLIN PRIVATE YES No%/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILYAX00978855 STOP 5
IN EFFECT
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
BRETT WILLET 12257 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED55725
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4821
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MATHEWS TIA E
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
27444 212TH PL SE MAPLE VALLEY WA 98038 5103967594 SEXi F MMDOYyry 03 - 16 - 2016
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. ( 9 6 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) KAUR INDERJ/T
ADDRESS&PHONE# DOB
16020 SE 144TH ST RENTON WA 98059 2067886338 SEX IF MMDDYVYY 11 _ 28 _ 1973
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS A
3 AIRBAG 6 RESTR. 4 EJECT 1 USE CLASS 6 BRASIONS FROM AIRBAG
NAME
(LAST FIRST,MIDDLE INITIAL) BOSCH GABRIEL T
AooREss PHONE# 607 QUINCY AVE NE RENTON WA 98059 4259996717 SEX M M D•O•B. 01 _ 30 _ 1974
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
BRETT WILLET 04-29-23 02:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 413012023 4:58:11 AM
BADGE OR ID# 112257 ORI#' WA0171300 TIME POLICE DISPATCHED; 11:19 AM TIME POLICE ARRIVED]11:22 AM
PART I PAGE IT]OF 4�
REPORT NO. ED55725 CASE# 23-4821 OF COLLISION
04/29/23 11:15
OF CbLLI510N
NARRATIVE
Portions of this incident were captured on my Body-Worn Camera. Please See that for complete
detail of witness statements and incident details.
On 04.29.2023, 1 was working for the Renton Police Department as 1-Robert-22, fully uniformed and
in a marked patrol vehicle. At approximately 1119 hours, I was dispatched to the intersection of Nile
Ave NE and NE 6th St in the City of Renton, County of King, and the State of Washington to
investigate a collision.
VEHICLES INVOLVED:
Unit# 01: 2019 Honda CR-V, WA LIC# BSZ7482
Occupied by: Shilpa R. Thomas (DOB: 11.24.1987)(Verified by WADOL)
Tia E. Mathews (DOB: 03.16.2016)
Unit# 02: 2021 Tesla Model Y, WA LIC# CAR0170
Occupied by: Majit Singh (DOB: 01.18.1972)(Verified by WADOL)
Inderjit Kaur (DOB: 11.28.1973)(Verified by WADOL)
INCIDENT:
Unit# 02 was traveling northbound on Nile Ave NE, approaching NE 6th St. Unit# 01 was stopped at
the stop sign at NE 6th (eastbound) and Nile Ave NE. Unit# 01 proceeded through the intersection to
continue east on NE 6th St from Nile Ave NE but failed to yield the right of way to Unit# 02 which had
the right of way.
Unit# 02 was unable to stop in time to avoid the collision and struck Unit# 01 on the passenger side of
the vehicle causing significant damage to both vehicles and multiple airbags to deploy.
Unit# 02 described having minor pain and abrasion from airbag deployment and Unit# 01 was shaken
but appeared to be uninjured. RFA came to the scene and evaluated all parties involved. No one
was transported.
Everyone stated they were wearing seatbelts and both vehicles were towed. Unit# 01, Shilpa R.
Thomas (DOB: 11.24.1987), was advised that a citation would be mailed to her for failing to yield the
right of way to Unit# 02.
Officer Desmet interviewed the witness who confirmed the details of the above statements and facts
regarding this incident. This ended my involvement in this incident.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
ELECTRONICALLY SIGNED
Officer B. Willet# 12257
Renton, WA/ County of King
State Of Washington
04.29.2023
1439 hours
PAGE 3 OF 4
REPORT NO. ED55725 CASE# ' 23-4821 DATE AND TIME 04/29/23 11:15
OF COLLISION
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Es.E
NOT TO SCALE
.a 202.3-4821
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unit#01
Unit#02
NE 6TH ST
PAGE 4 OF 4