HomeMy WebLinkAbout24-106 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-1os 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 01 - 1-— 2024 0735 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 2003
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2067866361 0 11
30
6� LAST NAME VIRK FIRSTNAME MAHADEEP MIDDLE S 1 1 2 31
INITIAL
STREET ❑, 19630 SE 184TH ST CITY RENTON ST WA ZIP 98058 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� AVA5476 sTArI WAvIN# 1GKS2JKJ9FR626587
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2015 C�MC YUKON UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO MAHADEEP S/NG 19630 SE 184TH ST RENTON WA 98058 D:2067866361 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATEFARM5146336-EO3.47 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
15❑ LEGALLv STANDING YES❑NO❑ CITATION# 1 o BOTTOM
8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2068836750
LAST NAME CHUA FIRST NAME MICHAELA MIDDLE K
INITIAL
17❑ STREET ❑', 13226 SE 187TH PL CITY RENTON ST WA ZIP 980588028 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LDI IVEW # STATE WA ]SEX IF M D.C.B. 11 26 _ 1989 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BUK9145 TAre WA vIN# 3CZRU6H5XLM707875
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE HOMC MODEL HRV STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DENNYLY 2535 S GRAHAM ST SEATTLEWA98108 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO ALLSTATE 2068336750IN 1UR,
vE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE39522
COLLISION REPORT III III III III III 111
1591972 CASE# 24-106
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) MEIS CHAD
ADDRESS&PHONE#
8455 50TH AVE S SEATTLE WA 98118 SEX M MMDDYyry 12 - 08 - 1987
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
�✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On January 4/20/24 at 0737 hours dispatch requested that I respond to a collision at 2003 Maple
valley highway in the city of Renton, King, WA.
Upon my arrival I spoke with the driver of unit 2 who stated they were going westbound on Maple
highway when the collision occurred. While they approached 2003 Maple Valley highway, unit 1
began to merge into their lane. Unit 1 failed to notice that unit 2 was beside them, striking unit 2 in
their driver side doors and wheel well.
I then spoke with the driver of unit 1 and they explained they were going westbound on Maple Valley
highway when they attempted to merge from the number 2 lane to the number 1 lane. As they
proceeded to merge, they failed to notice that unit 2 driving eastbound in the number 1 lane, colliding
with them and damaging their front right wheel. The collision caused his vehicle to be pushed
sideways sideswiping another vehicle that was in the roadway.
The third involved party left the scene prior to police arrival, so I was unable to contact them.
Both drivers refused any medical attention but both vehicles sustained severe damage. Both vehicles
were later towed by Bankers towing.
I also provided both drivers with an exchange of information form.
CC.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 01-04-24 09:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1/1112024 2:11:16 PM
BADGE OR ID# 1Y007 OR]#' ' WA0171300 TIME POLICE DISPATCHED! 7:38 AM TIME POLICE ARRIVED 7:41 AM
PART I PAGE IT]OF 3�
REPORT NO. EE39522 CASE# ' 24-106 DATE AND TIME 01/04/24 07:35
OF COLLISION
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