HomeMy WebLinkAbout24-2540 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-2540 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# ❑
cawsloN 03 - 1-- 2024 1746 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 180TH ST BLOCK NO. e✓ 8825
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2066617067 0 11
30
6� LAST NAME STAVE FIRSTNAME ALEXANDRA MIDDLE J 1 2 31
INITIAL
STREET ❑, 25630 158TH PL SE CITY COVINGTON ST WA Zlp' 980428287 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CMC2675 sTArI WAVIN# 3MVDMBAM8PM520407
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 3 34
13 2 2023 MAZD CX-30 UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ALEXANDRA STAVE31820162ND AVE SE AUBURN WA 98092 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO ALL STATE 964981196 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252818469
16 a
LAST NAME KHANDEKAR FIRST NAME SAMEER MIDDLE I P
INITIAL
17❑ STREET ❑', 14006 SE 6TH ST APT 15 CITY BELLEVUE ST WA ZIP 980077020 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 07 04 1968 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I CGT9311 TAre WA VIN# 7SAYGDEE6PF762435
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2023 MAKE TESL MODEL MODE!Y STYLE UT DEHICLE AMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO ALLSTATE 920647281IN STOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ 6
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. EE60151
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2540
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 March 7, 2024 at 1620 hour dispatch requested that I respond to a collision that occurred at S
180th St. and 88th Ave. South, in the city of Renton, county of king, and state of Washington.
Upon my arrival I spoke with the driver of unit 1 and they explained that they planned on making a left
turn from S 180th St. to the Starbucks parking lot in Kent. There was heavy traffic going eastbound,
but two vehicles stopped allowing a gap to be visible within traffic. These vehicles stopped in lanes 2
and 3, and waved driver 1 through. Driver 1 proceeded through the gap, but failed to see unit 2 in the
number 1 lane.
Unit 1 drove into unit 2's driver side fender.
I then spoke with the driver of unit 2 and they explained they were going eastbound in the number
one lane when the collision occurred. As they approached the entrance to Starbucks, unit 1 struck
their driver's side fender.
The two vehicles sustained moderate damage, disabling the two vehicles. The drivers stated they
were okay and no need for medical assistance was needed.
Later the two vehicles were removed from the scene by Gene Meyers towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 03-12-24 12:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 311812024 12:01:43 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED' 5:50 PM TIME POLICE ARRIVED',6:04 PM
PART I PAGE IT]OF 3�
REPORT NO. EE60151 CASE# ' 24-2540 DATE AND TIME 03/07/24 17:46
OF COLLISION
ON
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