HomeMy WebLinkAbout23-13681 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13681 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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 11 - 1-- 2023 1439 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE CARR RD MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 105TH P!SE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254060195 0 11
30
6 LAST NAME BATTH FIRSTNAME RANBIR MIDDLE S 1 2 31
INITIAL
STREET ❑ 6457 S 299TH ST CITY AUBURN ST WA ZIP 980012343 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CEW4317 sTArI WAvrN# 1 V2KR2CA8NC558763
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. TRLR $ 5 33
vIN#
12 3 5 ' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE ] $ 34
13 2 2022 VOLK ATLAS DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO RANJEETBATTH 6457 S 299TH ST AUBURN WA 980012343 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO NATL GENERAL 2019031796
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 3A0681741 FAIL YIELD LEFT TURN MOTOR I o aorroM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
YE
UNIT 02 VEHICLE ❑ ❑ ❑CYCLE OWNER ❑ S 1/ NO D:2063938890
16 a
LAST NAME MINDAYE FIRST NAME YAKOB MIDDLE I T
INITIAL
17❑ STREET ❑', 22692 129TH PL SE CITY KENT ST WA ZIP 980313978 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 LDIIVEW # STATE WA SEX M M .C.B. 05 _ 07 1982 0 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BRJ1925 TAre WA vIN1t JTDKARFU2H3533725
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2017 MAKE TOYT MODEL PRIUS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO YAKOB MINDAYE 22692129TH PL SE KENT WA 980313978 D:2063938890 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POLICY#E CO GEICO 6116-86-83-54IN 970E 5
vewcLE YES N❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY J
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE26990
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13681
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'
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.
M.LEVERTON 11-28-23 04:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/5/2023 11:22:10 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED' 2:39 Pry TIME POLICE ARRIVED',2:42 PM
PART I PAGE IT]OF 4�
REPORT NO. EE26990 CASE# 23-13681 OF COLLISION
11/28/23 14:39
OF CbLLI510N
NARRATIVE
red sedan/2 lane 1 eb blk suv/1 It wb to sb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at SE Carr Rd at 105th
PL SE.
I contacted the driver of unit 2 who told me he was eastbound in lane 1 SE Carr Rd when unit 1
turned across his lane and crashed into him. He did not complain of injury and damages required a
tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. Unit 1 explained that he was making a left turn
across traffic and since lane 2 was stopped that he could proceed. However, he crashed with unit 2.
He told me he was in the right because he was already making his turn. Damages did require a tow
truck. Unit 1 told me he was not hurt when I arrived on scene. When his mother arrived he told me
he wanted to go to the ER. Another family member said they would take him to VMC-ER about 1/2
mile away.
I cited unit 1 ref RCW 46.61.185 FTYROW-Left turn 2 car crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 11/28/2023
PAGE 3 OF 4
REPORT NO. EE26990 CASE# ' 23-13681 DATE AND TIME 11/28/23 14:39
OF COLLISION
i
l
PAGE 4 OF 4