HomeMy WebLinkAbout24-4831 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
SASE 24-4831 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 05 - 1-- 2024 1612 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
120TH AVE SE BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ,❑ FEET e S ❑ W e SE 160TH ST
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067422745 0 11
30
6❑ LAST NAME I TORRES VELASQUEZ FIRST NAME KEVIN MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 12500 SE 164TH ST CITY RENTON ST WA 21p 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 01 1- 29 - 1988 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE CKS2795 STATE WA V N# 1HGFA16548LO98543
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
rRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2008 HOND CIVIC 4D DAMAGE YES�NO YES❑ NO✓
REGISTEREDOWNERINFO --TORRES VELASQUEZ 12500SE 164THST RENTON WA 98058 D:2067422745 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI INSURANCE❑ INSURANCE CO 3 4
LI EFFECT l POLICV# 9TOP
ve EFFECT
CHARGE 5 36
LEIFALLY YES No clTAnoN# 4A0332258,4A0332258 FAIL STOP AT STOP 10 BorroM
15❑ STANDING 6
MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4083167251
LASTNAME NAGARAJA FIRST NAME SANDEEP MIDDLE M
INITIAL
17 STREET NEW ADDREs�' 3416 SE 18TH ST CITY RENTON ST WA ZIP 98058 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 DRIVER'S STATE WA SEX M I D.C... 107_ 07 1988 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE 1 ❑21❑ PLA E# CLH0530 TATE WA VIN 1 41
7PDSGABA2RN032117 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
G HI 44
VEH YEAR 2024 MAKE RELA MODEL R1S STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov YES
NO
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO NATIONWIDE 7246JO75743IN STOP
g
VEHICLE YES[:] ,.I—I CITATION# CHARGE �BOTTOM
LEGALLYN
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE86727
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4831
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MANOUR LAKSHMIJ
(LAST FIRST,
ADDRESS&PHONE# D O.B.
3416 SE 18TH ST RENTON WA 980583901 SEX F MMDDYyry 06 - 01 - 1990
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑' 2 POS. 3 1 4 1 USE 2 CLASS !1
NAME
`(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
TRAFFIC COLLISION
Kevin Adikh Torres Velasquez (DOB 01/29/1980) was driving his gray Honda Civic (CKS2795/WA)
(Unit 1) and, Sandeep Mysore Nagaraja (DOB 10/07/1988) was driving his gray Rivian R1s
(CLH0530/WA) (Unit 2). Both drivers were identified by their WADL.
Unit 1 was heading north on 120th Ave SE. Unit 2 was heading west on SE 160th ST. Unit 1
advanced into the intersection of 120th Ave SE and SE 160th ST colliding into unit 2.
1 cited unit 1 with (RCW 46.61.190) Vehicle entering stop or yielding intersection and (RCW
46.30.020) operating a motor vehicle without insurance.
Unit 2's vehicle is described as a Reliant in SECTOR. The vehicle is actually a Rivian R1s. The
SECTOR program did not allow this vehicle to be inputed as the registration describes it.
"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: 05/14/24at 2230 hours, Place: Renton, King County, WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEITH PETTY 05-05-24 07:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 6/14/2024 8:29:25 PM
BADGE OR ID# 12809 OR]#' WA0171300 TIME POLICE DISPATCHED 4:13 PM TIME POLICE ARRIVED',4:17 PM
PART I PAGE 2�OF❑
REPORT NO. EE86727 CASE# ' 24-4831 DATE AND TIME 05/05/24 16:12
OF COLLISION
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