HomeMy WebLinkAbout24-00548 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE42572 170
27
COLLISION REP FIT 1591971
SASE 24-00548 2
INTERSTATE ❑ CITY STREET FIRE R�RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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#
COLLISION'. 01 - 1-— 2024 1341 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a LIND AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:6618770718 0 11
30
6� LAST NAME NGUYEN FIRSTNAME TYANN MIDDLE 1 1 2 31
INITIAL
STREET ❑ 2523 NE 205TH ST CITY SHORELINE ST I WA 21p 98155 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USE ET 2 CLASS 0 NATURE OF INJURIES z❑
3
10[1P1 ATNES# CKF8096 sTAr WAv N# 5YJSA1 H11 EFP43588
11[-j0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 7 34
13 4 2014 TESL S SD DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4614591420 3 4
IN EFFECT &POLICY# 9TOP
VIC CHARGE 1 5 36
LECALLEHLEv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2538804089
16 a
LAST NAME KERN FIRST NAME ROBERT MIDDLE L
INITIAL
17 STREET NEW ADDRESS❑' 10305 SE 267TH ST CITY KENT ST WA ZIP 98030 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVERI #
❑ ON DUTY STATUS I
AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# AAV5239 TArE 41
WA VIN# 5J6YH2H76AL005254 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE HOND MODEL ELEMENT STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO
REGISTERED OWNER INFO ROBERT KERN 10305 SE 267TH ST KENT WA 98030 D:2538804009 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO FARMERS 2591946880IN STOP 5
VEHICLE ❑ C[:] CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 8 7 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE42572
COLLISION REPORT III III III III III 111
1591972 CASE# 24-00548
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.
KEITH PETTY 01-16-24 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1/21/2024 2:15:42 PM
BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED 1:43 PM TIME POLICE ARRIVED',1:49 PM
PART I PAGE IT]OF 4�
REPORT NO. EE42572 CASE# 24-00548 OF COLLISION
01/16/24 13:41
OF CbLLI510N
NARRATIVE
On 01/16/2024 at approximately 1343 hours I was dispatched to a non-blocking collision with injuries
located at the intersection of SW Grady Way and Lind Ave SW in the City of Renton, County of King,
State of Washington.
Upon arrival, I viewed 2 vehicles at the side of Lind Ave SW just north of the intersection. Vehicle 1
(V1) is a Red 2014 Tesla Model S (CKF8096/WA), and Vehicle 2 (V2) is an orange 2010 Honda
Element (AAV5239/WA).
V1 was traveling east on SW Grady and attempted to turn North onto Lind Ave SW colliding with V2
who was traveling west on SW Grady Way. V2 stated he had a greenlight and V1 stated she had a
solid yellow left turn signal.
This concludes my involvement.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed:K.Petty, Date: 01/16/24lace: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EE42572 CASE# ' 24-00548 DATE AND TIME 01/16/24 13:41
OF COLLISION
Y WAY
NOT TO, SCALE
1 ,
ii
i
PAGE 4 OF 4
