HomeMy WebLinkAbout23-6255 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6255 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 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 06 - 1-- 2023 0857 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
OAKESDALEAVESW ST e✓
MILEPOST 2700 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SW 27TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069491739 1 6 30
6� LAST NAME KIHLSTROM FIRSTNAME ROBERT MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 7120 SUNNYCREST RD CITY SEATTLE ST I WA 2jp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ PI ATFBit BfV4405 sTAr� WA urN#' WAUKD78P56A085845
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 5 1 34
13 2 2006 AUDI A3 GA DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 952899328 4
IN EFFECT &POLICY# 9TOP
VE— CHAR 10 GE BOTTOM 5 36
LEGALLY Yes❑NO❑ CITATION#
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2063357616
16 a
LAST NAME JHALLI FIRST NAME GURDEEP MIDDLE K
INITIAL
17❑ STREET ❑', 11824 SE 236TH ST CITY KENT ST WA ZIP 980313606 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVEW # STATE WA SEX F M D.C.B. 09 _ 16 _ 1980 El 39
F—NATURE OF
20❑ ON DUTY STATUS AIRBAG,6 RESTR 2 EJECT 1 WEB MEET LAU SY 6 LEFT SIDE OFRIES NECK,LEFT ARM AND LEFT LEG ❑ 40
21❑ LICENSE BXT4700 TArE WA VIN# 1HGCV1F36LA133870
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE HOND MODEL ACCORD STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SARBJIT SINGH 25425155TH AVE SE COVINGTON WA 98042 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 957327139IN STOP 5
VEwGLE ❑ N,J� CITATION# CHARGE io BOTTOM
LEGALLY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.STEED 8770 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED66349
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6255
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
POS. 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'
On 06/02/23 at about 0904 hrs I arrived at Oakesdale Ave SW and SW 27th St for an injury accident
report, in the City of Renton, County of King, and State of Washington. After speaking with both
involved drivers Unit#2 was NB on Oakesdale Ave SW approaching SW 27th St with the right of way.
Unit#1 was coming from SB Oakesdale Ave SW and was making an EB turn on to SW 27th St. Unit
#1 driver advised there was a semi blocking his view of NB traffic on Oakesdale and he thought it was
clear to proceed. Unit#1 pulled in front of Unit#2 who tried stopping to avoid the collision but was
unable. Unit#2 struck the passenger side of Unit#1 pushing both vehicles to the NE corner of the
intersection. Unit#2 also struck a fire hydrant with the driver's door. The fire hydrant remained intact.
Driver#2 complained of soreness on the left side of her neck, left arm, and left leg. Driver#1 advised
he was uninjured. Both drivers were seen by Renton Fire. Both vehicles had to be impounded by
Banker's towing.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed by Officer Steed on 06/02/23 1003 hrs, Renton Washington
Cassidy Steed/8770
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 06-02-23 10:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 6/2/2023 3:30:18 PM
BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED 8:88 AM TIME POLICE ARRIVED,9:04 AM
FART I PAGE IT]OF 3�
REPORT NO. ED66349 CASE# 23-6255 DATE AND TIME 06/02/23 08:57
OF COLLISION
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