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HomeMy WebLinkAbout24-5599 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SASE 24-5599 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 05 - 1-- 2024 1431 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 3RD ST BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BLA/NEAVENE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252709551 N:4252601552 0 11
30
6� LAST NAME LUJAN FIRSTNAME LUCILLE MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 13311 191 ST AVE SE CITY RENTON ST WA 2jp, 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ 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 aTES� CLR5769 sTATI WAurN# 3VWB17AJ4EM412848
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/g[ GOVT.VEHICLE 34
13 4 2014 VOLK JETTA SD D AMA G 3 7 E YES NO YES❑ No✓
REGISTERED OWNER INFO LEANN BOSCOE 11111191STAVE SE RENTON WA 98059 D:4252601552 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO BRISTOL WEST GO1.3234557.01 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:6305187353
16 a
LAST NAME VASU FIRST NAME SRINIVASA MIDDLE P
INITIAL
17 STREET❑ NEW ADOREss❑' 509 SHADOW AVE NE CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK yEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 04 23 _ 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS TIGHT BACK
❑21❑ PLATE# APJ2921 TATE 41
WA VIN# 2T3BFREVODW040886 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GoI
VEH YEAR 2013 MAKE ]'DY)' MODEL RA V4 D
STYLE UT AMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO ESURANCE INSURANCE COMPANY PAWA-005099974 I STOP
IN EFFECT
'E""LE ,J� CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES❑ N`L I
$ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
TIM CUMMING 11488 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE81137
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5599
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SRINIVAS SHRIMAN
(LAST FIRST,
ADDRESS&PHONE#
509 SHADOW AVE NE RENTON WA 98059 6305187353 SEX M MMDOYyry 11 - 08 - 2010
PASSENGER I�I WITNESS 'UNIT# 2 POS 3 AIRBAG!2 RESTR. 4 EJECT ? 1 H U SE 2 CLASS 1 NATURE of INJURIES
NAME L�1
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
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.Q.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.
TIM CUMMING 05-27-24 03:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 512812024 2:24:18 PM
BADGE OR ID# 11488 OR]# WA0171300 TIME POLICE DISPATCHED; 2:37 Pry] TIME POLICE ARRIVED',2:39 PM
PART I PAGE IT]OF 4�
REPORT NO. EE81137 CASE# 24-5599 OF COLLISION
05/27/24 14:31
OF CbLLI510N
NARRATIVE
24-5599
On 05/27/2024 at approximately 1437 hours, I was working as a Police Officer for the city of Renton.
While I was working, I was dispatched to a blocking collision at NE 3rd St and Blaine Ave NE, in the
City of Renton, the County of King, State of Washington.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized. My involvement in this incident was captured
on my department issued Axon body camera. For exact statements made during my investigation
please see my Axon camera footage.
According to the notes in the call, there was a two-vehicle collision with no injuries. They were
blocking the westbound lanes. Both parties pulled over to Blaine Ave NE. The first vehicle (unit 1)
was a gray 2014 Volkswagen Jetta 4 door sedan (WA LIC# CLR5769). The second vehicle (unit 2)
was a black Toyota Rav4 SUV (WA LIC#APJ2921)
I arrived on scene around 1439 hours. When I arrived on scene, I saw 2 damaged cars matching the
description that dispatch provided.
Unit 1 had damage to the front of the vehicle. The airbags all around the interior of the vehicle had
gone off. The driver of the car was identified as Lucille Juanita Morrison Lujan (DOB 10/06/2006).
Her identity was later confirmed by WADL/WAID photo.
Unit 2 had damage to the rear of the vehicle. No airbags had gone off. The driver of the car was
identified as Srinivasa Prabhu Vasu (DOB 04/23/1979). His identity was later confirmed by
WADL/WAID photo. The passenger of Unit 2 was identified as Shriman Srinivas (DOB 11/08/2010).
Shriman told me that Srinivasa was his father.
Neither party complained of pain but since airbags had been deployed for Unit 1, Renton Fire was
called to the scene. All parties were given a chance to seek medical attention.
I met with the driver of Unit 1. The following is Lujan's statement;
Unit 1 was traveling west along NE 3rd St in lane 2. She saw traffic start to slow so she did. As she
was slowing, she heard what sounded like a crash behind her, so she took her eyes off the road to
see what happened. She believed that someone had collided with her. When she took her eyes off
the road, she collided with Unit 2. She told me that she later found a scratch on the rear passenger
side of her car that was new. She believed that a car following her scratched her car while they went
around her car to avoid the traffic slow down. She showed me a scratch on her rear passenger side
that she said was new and was likely caused by the unidentified car that went around her to avoid the
traffic. Lujan stated she was wearing her seatbelt at the time of the crash.
I met with the driver of Unit 2. The following is Vasu's statement;
Unit 2 was traveling west along NE 3rd St in lane 2. He saw traffic start to slow so he did. As he
came to a stop, Unit 1 collided with the back of his vehicle. He told me that his back was tight but he
was not injured. He told me that he was wearing his seatbelt at the time of the collision. 1 talked to
his son, Shriman who confirmed Vasu's statements. Shriman said he was wearing his seatbelt at the
time of the collision. Both parties stated that they did not see a car collide with the back of Unit 1.
All parties provided me with their required information. Photos were taken of the scene and uploaded
to evidence.com.
Unit 1 was leaking fluids and all the airbags had gone off. Bankers towing was called at the owner's
request.
Based on all of the information gathered, I am not able to determine which driver was at fault. Neither
Unit 1 or Unit 2 could provide any details regarding the possible 3rd car that was involved in the
incident.
There is no further information available at this time.
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 T. Cumming #11488 on 05/27/2024 @ 1532 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EE81137 CASE# ' 24-5599 DATE AND TIME 05/27/24 14:31
OF COLLISION
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