HomeMy WebLinkAbout23-9154 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-9154 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 5 6 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cawsloN 08 - 09 - 2023 1930 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
WILLIAMS AVE S BLOCK NO.
e 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO F,/ D:4258917279 30
6❑ LAST NAME ONESY FIRSTNAME NALANH MIDDLE 1 2 31
INITIAL
STREET ❑, 228 WILLIAMS AVE N CITY RENTON ST WA Zjp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
$ LDICENSE#RIVERS STATE WA SEX'F MI ovY 12 - 03 - 1972 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9� Pi ATNES14 BUC7234 STATE WA VIN# JTMRWRFV6LD060827
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12❑ VIN#' VIN#
FROM TO
❑ VEH.YEAR 2020 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 TOYT RAV4 UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO STATEFARM 4044685D2847A 3 4
IN EFFECT &POLICY# 9TOP
vEHICLe 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2063721994
16 a
LAST NAME APPAHAMI FIRST NAME SULAKSHA MIDDLE L
INITIAL
17 STREET NEW ADOREs7 524 WHITWORTH AVE S CITY RENTON ST WA ZIP 98057 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS # STATE SEX M MMDDYY —�_ 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT WEB MEET CLASINJURS LACERATION
6 [NATURE OF INJURIES LACERATION TO HEAD/MINR SCRAPES HANDS 40
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4 0 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I vE."LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N J
s � e
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 1 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88760
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9154
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JONES DEJAYAA
(I.P.ST FIRST,
ADDRESS&PHONE#
20022 100TH AVE SE KENT WA 98031 2532049195 SEXi F MMDOYyry 09 - OS - 1997
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) ALLEN ALEXA K
ADDRESS&PHONE# D O B
101 EAST RD TACOMA WA 98406 2533200820 SEX u MMDDYvvv 07 _ 04 _ 1998
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
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'
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.
BRYAN GROZAV 08-10-23 12:52 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 8/13/2023 12:44:46 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 7:32 Pry] TIME POLICE ARRIVED',7:34 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED88760 CASE# 23-9154 OF COLLISION
08/09/23 19:30
OF CbLLI510N
NARRATIVE
CASE 23-9154
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Wednesday August 9th, 2023, at approximately 19:32, 1 responded to a 911 call regarding a
vehicle versus pedestrian collision in front of the Liberty Square Apartments located at 417 Williams
Ave S within the City limits of Renton, King County, Washington.
-UNIT ONE: SILVER 2020 TOYOTA RAV4 WASHINGTON LICENSE: BUC7234
-UNIT ONE DRIVER: NALANH ONESY (DOB: 12.03.1972)
-JUVI PEDESTRIAN: SULAKSHA L APPAHAMI (DOB: 9.22.2016)
'CALL REMARKS: PEDESTRIAN VS VEH - ON WILLIAMS - CONS, BLEEDING FROM HEAD. PT
IS 6-7 YO MALE - PHONE PASSED TO INVLD DRIVER.
Upon arriving on scene, Renton Fire was already on scene triaging Sulaksha's injuries. Sulaksha had
a laceration to his head and scrapes to his hands. Sulaksha was transported to Valley Medical Center
by Renton Fire.
I contacted Nalanh who said she was driving south on Williams Ave S in the 400 block when
Sulaksha ran out in front of her car. She tried to avoid Sulaksha but did not have enough time to
react. Nalanh was not injured, and her vehicle was not damaged.
Several witnesses on scene including Alexa K. Allen (DOB:7.04.1998) and De'Jaya A. Jones
(DOB:9.05.1997) reported Sulaksha ran down the stairs from the Liberty Square Apartments and run
into the street in front of Nalanh's vehicle.
I provided Nalanh and Sulaksha's mother, Lakshika N. Mahamal (DOB: 4.29.1988) a business card
with the case number and informed them the incident would be documented in a police report.
This concludes my involvement in this case.
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 B. Grozav #12489 on 8.10.2023 at 00:52 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED8 7 O CASE# 23-915 A m°M\ O&0/23 ]$3
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