HomeMy WebLinkAbout23-12646 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-12646 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 11 - 1-- 2023 0429 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
EASTVALLEYRD ST e✓
MILEPOST 4100 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ w SW4IST ST
0 1 29
UNIT 01 VEHICLE
MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLD MET PHONE 0 8 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE#
STA fE I
SEX u MMDOBYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR 5 1. TRLR 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VN VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO 23-12646 UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ IN CO 3 4
IN EFFECT S POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062292052
16 a
LAST NAME SINGH FIRST NAME SHUBPREET MIDDLE
INITIAL
17❑ STREET I 22727 97TH AVE S CITY KENT ST WA ZIP 98031 37
ADOREsS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO
19 LDI IVE STATE WA SEX M M D.C.B. 10 _ 11 1996 El 39
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
LICENSE I ❑21❑ PLA E# BJR2946 TATe WA VIN 41
# 4T1B21HKXKU014249 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2019 MAKE TOYT MODEL CAMRY STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MANPREET SINGH 2272797TH AVE S KENT WA 98031 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE &POINSURGY#E CO SAFECO H2512065IN STOP
VEHICLE CITATION# CHARGE
25❑ [AGENCY
to BOTTOM
LEGALLY YES N�
7Q-,u,,
S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
TIBEAU 07691 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE16084
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12646
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.
QUINT TIBEAU 11-03-23 06:23 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 111312023 2:57:27 PM
BADGE OR ID# 07691 OR]# ! WA0171300 TIME POLICE DISPATCHED 4:34 AM TIME POLICE ARRIVED]4:38 AM
PART I PAGE IT]OF 5�
REPORT NO. EE16084 CASE# 23-12646 OF COLLISION
11/03/23 04:29
OF CbLLI510N
NARRATIVE
23-12646
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
On 11/03/2023 at about 0434 hours I was dispatched to the area of East Valley RD and SW 41st St
for a Hit and Run collision. I arrived at about 0438 hours and contacted the driver and sole occupant
of vehicle #2, who identified himself as Shubpreet Singh with his WADL. Singh stated that he was
stopped for a red light on northbound East Valley Road behind vehicle #3. He heard screeching and
was then struck from the rear by vehicle #1, which pushed him into the back of vehicle #3. Vehicle #1
then made a U-turn and fled southbound on East Valley Road. Singh could only describe vehicle #1
as a tan minivan.
I then spoke to the driver and sole occupant of vehicle #3, who identified himself as Darrick Williams
with his WADL. Williams stated that he was stopped at the red light on East Valley Road at SW 41 st
St, when he heard screeching of tires, and was struck from the rear, pushing him through the
intersection. He did not get a look at vehicle #1 at all.
Williams and Singh exchanged information. 1 provided them with the case number for their
insurance.
I took digital photographs of the vehicles and later uploaded them to evidence.com.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
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 Q. Tibeau 11/03/23 0604 hours, Renton, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE16084
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-12646
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR
PEDAL-
5 ❑ AL � PROPERTY � YD OLDMET PHONE# 3 VEHICLE CYCL PEDESTRIAN OW G
� 8 29
LAST NAME WILLIAMS FIRST NAME DARRICK MIDDLE L
INITIAL
STREET 30
NEW AnDRFSP' 16819 SE 278TH PL CITY COVINGTON ST WA ZIP 98042
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO zERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX U MMDDYYv 07 - 28 - 1971
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BNM0938 [TAT WA VIN# JF1SG65663H704400
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH11' P FROM TO
2003 SUBA FORESTS GA DAMAGE YES NO YES NO
REGISTERED OWNER INFOCHRISTIANE COCO 22632 SE 240TH ST#C301 MAPLE VALLEY WA 98038 SHADE IN DAMAGED AREA R 9 33
12 a
LIABILITY
INSURANCE INSURANCE CO STATE FARM 528 8932-E16.47 R�i"01 FROM To
IN EFFECT &POLICY# 1
LEGA LE m 34
13 ❑ LEGALLY YES NO❑ CITATION# CHARGE 0 BOTTUM
STANDING �} � 7
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
STREET"[-]
16 NEW nnR CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE VIN#
PLATE# rnr
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeGALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
QUINT TIBEAU 11-03-23 06:23 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 07691 O#IL WA0171300 SKELTON 111312023 PAGE F OF 5
3000-345-013(R 11118)
REPORT NO.! EE16084 CASE# ' 23-12646 DATE AND TIME 11/03/23 04:29
OF COLLISION
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{/a
East Valley Rd
0
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PAGE 5 OF 5