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HomeMy WebLinkAbout24-12164 ("7—
STATE.w,-" .:.. TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 1 27c .
COLLISION REP F 1591971
CASE 24-12164 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 2 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 11 - 24 - 2024 1520 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108THAVESE BLOCK NO.
8 17800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET e S e W 8 SE PETROVITSKYRD
2 0 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YE ,/NO D:9375540357 1 2 30
6 LAST NAME KANDUKURI FIRST NAME MONOHAR MIDDLE R 1 2 31
INITIAL
STREET 22921 POPLAR AVE SE CITY BLACK DIAMOND WA
NEWADDREss S7 ZIP 98010 z
7❑ CDL IGNITION REQUI �RED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs No / INTERLOCK YEs No�/ YES NO,/
8❑ LDIRIVER' STATE WA SEX'M MM,:B 05 - 17 - 1998 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET E7 2 ��SS I 1 NATURE OF INJURIES 2
LICn NSE CNG7400 STATE WA WIN# KNMAT2MTXGP636244 3
10 9❑
11 3 5 PLATE# STATE PLATE#TRAILER STATE FROM TO
TRAILER
TRLR TRLR.# 1 5 33
12 3 5 VIN#' VIN
FROM TO
13 4 VEH.YEAR2016 MAKE NISS MODEL ROGUE STYLE UT VEHICLE TOWED 2NODi�ABLIN TvR EBYMEYER GOVV�EHI LE 1 $ 34
❑ DAMAGE II1I._IIII -IIJJ
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE 1N DAMAGED AREA ❑ 35
4 LIABILITY INSURANCE INSURANCE CO ft
14 PROGRESSIVE 950760303
IN EFFECT &POLICY# STOP
VEHICLE YES CHARGE ❑ 36
EGnu v ❑NO❑ CITATION# 10 ftOTTOM
1 S❑ srAnomc 7 6
MOTOR � PEDAL PROPERTY M THR OLD MET PHONE
UNIT ICJ ❑ PEDESTRIAN ❑ OIL HO 7147579562
VEHICLE CYCLE OWNER S NO
16�
LAST NAME DAVIDSON FIRST NAME ' SAMEEN MIDDLE ' R
INITIAL
17 STREET El 11235 SE 186TH ST CITY RENTON ST', WA ZIP 98055 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED 3$
W7ERLOCKvE No INTERLOCkCvEs no ves No,�
19[ DRIVER'#
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U E7 2 INJURYNATURE OF INJURIES 40
❑21❑ LICENSE 41
,BKP1274 TATf'WA vIN 2T36F4DV3CW261708 1
PLATE# #
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
44
VEH.YEAR 2012 MAKE 7'OYT MODEL RAV4 STYLE UT DAMIAGE TOWED NO✓O BLIN TOWED BY GO YES N HI O�/
24 YES
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO AMERICAN HOME CONNECT BX13273826
IN EFFECT &POLICY# t 4TOP 5
Venice YES❑ N U CITATION# CHARGE tOBOTTQM
LEGALLY
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JAREN JOKELA I i 12805 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF44867
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12164
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJU S' NATURE OF INJURIES
❑ ❑ PC& I 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.
JAREN JOKELA 11-24-24 05:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 1211112024 3:24:27 PM
BADGE OR ID# 12805 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 Pry/ TIME POLICE ARRIVED i 3:29 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F5
E AND
REPORT NO. EF44867 CASE# 24-12164 OFCOLLIION 11/2412415:20
OF COLLISION
NARRATIVE
Renton Case #24-12164
On 11/24/2024 at 1523 hours I was dispatched to the 17800 block of 108th Ave Se, in the City of
Renton, King County, Washington. I was responding to a call of non-injury, blocking accident. This
incident was captured on my body worn video camera. This report is a summation of events that
occurred and is not an exact sequence of events.
While en route, dispatch advised the following: Two motor vehicle collision, no injuries, blocking
southbound on 108th.
At approximately 1528 hours, I arrived on scene located the two involved vehicles. Unit 1 and Unit 2
vehicles were blocking the number 2 lane of southbound travel on 108th Ave SE, just south of SE
Petrovitsky RD.
I identified Unit 1 as a white 2016 Nissan Rogue (WA LIC # CNG7400) being driven by the registered
owner of the vehicle, identified by his WA DL as Manohar R Kandukuri (DOB 05/17/1998).
Unit 1 driver told me he was not injured. I asked Unit 1 driver what happened, he stated that he was
traveling southbound on 108th Ave SE in the number 2 lane of travel. Unit 1 driver said that as he
continued southbound, Unit 2 vehicle exited the Fred Meyer parking lot (located at 17801 108th Ave
SE), into his lane of travel, striking the side of his vehicle. Unit 1 said that after being struck by Unit 2
vehicle, he then lost control of his vehicle, resulting in him veering partially off the roadway and into a
small landscape hedge.
I observed a right rear flat tire, and minor body damage as a result of the collision.
Unit 1 driver provided me with his WADL, registration and proof of insurance.
I identified Unit 2 as a gray 2012 Toyota Rav4 (WA LIC # BKP1274) being driven by Unit 2 driver,
identified by her WA DL as Sameen R Davidson (DOB 09/25/1985). No other occupants were in the
vehicle of Unit 2.
Unit 2 driver told me she was not injured. I asked Unit 2 driver what happened, she stated that she
was exiting the Fred Meyer parking lot, setting up to go southbound on 108th Ave SE. Unit 2 driver
said that when she started her initial turn onto 108th, lane number 2 was clear and no oncoming
traffic occupied the lane of travel. Unit 2 driver continued stating that as she continued her turn, Unit 1
vehicle merged from the number 1 lane of travel, into the number 2 lane of travel, in which she had
started her turn into. Unit 2 driver said that Unit 1 vehicle collided with the left front of her vehicle,
causing Unit 1 vehicle to lose control, ending up partially off the roadway in front of her.
I observed damage to the front left of Unit 2 vehicle, consistent with the information provided by Unit 2
driver.
Unit 2 driver provided me with her WADL, registration and proof of insurance.
Photographs of both vehicles were taken at the scene along with the sustained vehicle damage to
each unit. All photos were later uploaded to Axon Evidence.
I provided each involved unit with a business card, case number and answered their remaining
questions.
Gene Meyer Towing was dispatched and removed Unit 1 from the scene. Unit 2 cleared the scene
PAGE 3 OF 5
E AND
REPORT NO. EF44867 CASE# 24-12164 OFCOLLIION 11/2412415:20
OF COLLISION
NARRATIVE
unassisted.
I then cleared the scene.
This ends my report.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. Jaren Jokela #12805, 11/24/2024 at 1651 hours in Renton, Washington.
PAGE 4 OF 5
REPORT NO. EF44867 CASE# 24-12164 DATE AND TIME 11/24/2415:20
OF COLLISION
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PAGE 5 OF 5