HomeMy WebLinkAbout23-5720 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5720 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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#
GawsloN 05 - 1-- 2023 1251 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 3RD ST BLOCK NO. e✓ 1500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e FACTORYAVE N
0 1 29
UNIT MOTOR
Z PEDAL ❑ YESA,GEE NHORESHOLD MET PHONE 0 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 25 VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R 1 34
13 1 UNKN UNKNO 4D DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICV# 9TOP
vewcLe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
UNIT 02
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
❑VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2063316952
16 a
LAST NAME KAUR FIRST NAME SUKHDEEP MIDDLE N
INITIAL
17❑ STREET Is❑' 24208 114TH PL SE CITY' KENT ST WA ZIP 980306854 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL t-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF t l YES NO�
19 DRIVER'S STATE WA ]SEX IF I D.C.B. O6 1_ 01 _ 1987 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS NECK PAIN
❑21❑ PLATE# CDV4669 TATE 41
WA VIN# 5YJ3E1EC1NF296730 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE TESL MODEL MODELS STYLE 2D VEHICLE TOWED TO BLIN TOWEDeY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JASPREET SINGH 24208114TH PL SE KENT WA 98030 D:2063316952 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 921575543IN I STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N J 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
P.LANTAGNE 12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED66289
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5720
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
PM 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'
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.
P.LANTAGNE 05-21-23 04:52 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 6/2/2023 11:51:11 AM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 2i08 Pry TIME POLICE ARRIVED:2:20 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED66289 CASE# 23-5720 OF COLLISION05/21/23 12:51
NARRATIVE
23-5720
On 05/21/2023 at approximately 1251 hours, I, Officer Lantagne, responded to a non-blocking, injury
collision which occurred at the intersection of N 3rd ST and Factory AVE N, which is located in the
City of Renton, County of King, and the State of Washington. I responded in my fully marked police
vehicle, wearing my patrol uniform.
I arrived on scene and observed Unit#2, a 2022 Tesla Model 3 with license plates CDV4669 issued
out of Washington State, parked on Factory AVE N just to the north of the intersection. I was advised
by the driver of Unit#2, Sukhdeep Kaur (DOB 06/01/1987), that she had neck pain.
Kaur told me the following: Kaur was driving eastbound on N 3rd ST. Kaur began to make a left turn
onto Factory AVE N. As Kaur was making the left turn, a blue or grey sedan driving behind her
attempted to overtake her vehicle on the left and the front right bumper of the vehicle struck the
driver's side door of Kaur's vehicle. Before Kaur could get her phone out, the vehicle fled northbound
on Factory AVE N. Kaur was not able to identify what type of vehicle it was or who was driving it.
I observed the damage to the vehicle and other physical evidence was consistent with the statements
made by Kaur. Unit#2 had significant damage to the driver's side door which was crumpled in and
could not be opened.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Kaur. I spoke with a witness, Abdullahi Hassan (DOB
04/29/1994), and he advised me he did not see the collision but came outside after he heard it and
observed the blue sedan pinning the driver's side door of the Tesla. Hassan could not identify the
driver and was not able to get a license plate.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1636 hours on 05/21/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. ED66289 CASE# ' 23-5720 DATE AND TIME 05/21/23 12:51
OF COLLISION
Unit#1 Factory AVE N
Casa#23-5720
N
Not try Scala
P. Lantagna#1257
f,.
N 3rd ST Unit#2
PAGE 4 OF 4