HomeMy WebLinkAbout24-7909 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SAS 24asos 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1❑ OF 1 $ 1 28
TOTAL#
TRIBAL UNITS 02 OBJECT STRUCK' TRAFFIC SIGNAL POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CtLLISION' 07 - 1-- 2024 2003 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LIND AVE SW BLOCK NO. e✓ 4100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ❑ FEET e S ❑ w SW4IST ST
❑
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254456838 0 11
30
6� LAST NAME KOTHARI FIRSTNAME HEMAL MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 23988 SE 8TH PL CITY SAMMAMISH ST WA 2jp, 98075 z
NEW
ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� ELECFRY5 sTATI WAurN# 5YJYGDEE6LF057920
TRAILER STATE TRAILER STATE
11 0 0 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 TR Y GOVT.VEHICLE 1 $ 34
13 8 2020 TESL MODEL SV DAMAGE YES NO MEYER'S YES[:] NO✓
REGISTERED OWNER INFO HEMAL KOThARI 23988 SE 8TH PL SAMMAMISH WA 98075 D:4254456838 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO AMICA MUTUAL INSURANCE 94084624GJ 4
IN EFFECT z &POLICY# 9TOP
15❑ LE
vECAIIv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2068473357
16 2
LAST NAME MAHASONGKHAM FIRST NAME TA O MIDDLE
INITIAL
17 STREET NEW ADOREs7 12601 68TH AVE S 8D CITY SEATTLE ST WA ZIP 98178 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] D IVEW #
❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 WEB SET 2 NJAURSY 6 COMPLAINT OF CHEST PAIN ❑F—NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AHY5618 TATE 41
WA YIN# 2T3BF4DV1CW191478 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2012 MAKE TOY'/' MODEL RAV4 STYLE SV VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO TAO MAHASONGKHAM 1260168TH AVE S 8D SEATTLE WA 98178 D:2068473357 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE❑ &POINSURGY#E CO STATE FARM 008 0608F2947CIN STOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N J
' a
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 SWAN 7 12965 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF02464
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7909
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KOTHARI SUSMITHA H
(LAST FIRST,
ADDRESS&PHONE# D O.B.
23988 SE 8TH PL SAMMAMISH WA 98075 4258947923 SEXi F MMDOYyry 10 - 10 - 1969
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 1 POS, 3 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 7 AIRBAG IMPACTAND SEATBELT
TIGHTENING
NAME
(LAST,FIRST,MIDDLE INITIAL) MUSSE ABDIFATA✓
ADDRESS&PHONE# D O Bvvv 01 15712 39TH PL S#E2 TUKWILA WA 98188 2065570834 SEX M MMDDY _ 01 _ 1981
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ SEA USE CLASS
NAME
(LAST FIR57 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'
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.
NICHOLAS SWAN 07-28-24 12:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 81512024 2:22:25 PM
BADGE OR ID# ! 12965 (DR]# WA0171300 TIME POLICE DISPATCHED; 8:03 Pry] TIME POLICE ARRIVED',8:10 PM
PART I PAGE IT]OF 4]
REPORT NO. EF02464 CASE# 24-7909 OF COLLISION
07/27/24 20:03
OF CbLLI510N
NARRATIVE
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 07/27/2024 at approximately 2003 hours I was dispatched to the intersection of Lind Ave SW and
SW 41 st ST in the city of Renton, King County, WA, for a two-vehicle collision that occurred with
unknown injuries.
While enroute to the location, dispatch advised that a single female was yelling for help.
I arrived on scene and found Unit 1 a blue 2012 Toyota RAV4 with WA LIC: AHY5618 and Unit 2 a
blue 2020 Tesla Model Y with WA LIC: ELCTRY5. The two vehicles had collided with one another
and came to rest on north west corner of the intersection. All traffic control lights at the intersection
were out as a power box had been damaged.
Driver 1 of Unit 1 was traveling south on Lind Ave SW in lane 1. The driver of Unit 1 was transported
to Valley Medical Center with reported chest pain and was not able to provide a statement before
being transported. I went to the hospital after the scene was cleared and she was still having difficulty
speaking and was unable to provide a complete interview.
Driver 2 of Unit 2 stated he had just got off of Hwy 167 and was enroute to Ikea. He was traveling
west on SW 41st ST and stated that his light was green. As he entered the intersection, he stated that
Unit 1 appeared out of nowhere and they collided into the traffic pole and a utility box. The passenger
in Unit 2 was transported to Valley Medical Center with reports of pain from the airbag deployment
and her seatbelt tightening upon impact.
A witness at the scene confirmed the direction of travel by Unit 2. He stated that Unit 1 was turning
west on to SW 41st ST but could not recall the status of the lights at the intersection. He did state he
had a red light though as we he was waiting to turn east on to SW 41 st ST. Video footage is available
from his dash camera and an Axon Community link was sent to him.
Both vehicles were towed away from the scene by Gene Meyer's and Bankers towing. Unit 1 was
towed by Banker's towing. A tow form was provided to driver 1 at Valley Medical Center. Driver 2
signed a tow form for his vehicle as he was still on scene.
Officer Tamaivena took pictures of the scene and uploaded them to Axon Evidence.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 failing to yield before making a right hand turn to travel west on SW 41st ST. The driver of Unit
1 was issued citation #4A0612845.
If Unit 1 did not proceed with turning west on to SW 41st St before the intersection was clear of
oncoming traffic, then this collision would not have occurred.
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 Officer N. Swan #12965 on 7/28/2024 at 0028 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EF02464 CASE# 24-7909 DATE AND TIME 07/27/24 20:03
OF COLLISION
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