HomeMy WebLinkAbout25-126 a Tc"oucE RaFFi II IfI) 11�1 . a 5 27 If I REPORT NO EF54547
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE zs-1zs 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 01 - 1-- 2025 1914 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
GARDEN AVE NORTH BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NORTH 10 ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257574744 0 11
30
6❑ LAST NAME NTENSIKA FIRSTNAME NGEMA MIDDLE 1 2 31
INITIAL
STREET ❑✓ 479 HARRINGTON AVE NE CITY RENTON ST WA ZIP 98056 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
ELOB 07 1- 15 - 1985 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CPM8613 sTArI WAurN# 3FADPOt37AR234789
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2010 FORD FUSION SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 990603534 3 4
IN EFFECT &POLICY# 9TOP
VEH" CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:2063805525
16 a
LAST NAME HUNDAL FIRST NAME BHUPINDER MIDDLE S
INITIAL
17 STREETNEW ADDR11 25425 155TH AVE SE CITY COVINGTON ST WA ZIP 98042 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK yyEEsl I I NOF YES
t l NO�
19 D IVEW # STATE WA SEX M M D.C.B. 05 _ 21 1972 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLA E# BST3487 TArE WA VIN# 4T1K61AK3LU328339 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2020 MAKE 7'Dy7' MODEL CAMPY STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO SAFECO H2507105IN I STOP 5
VE."LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF54547
COLLISION REPORT III III III III III 111
1591972 CASE# 25-126
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.
BRYAN GROZAV 01-05-25 07:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 11912025 1:51:00 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 7:97 Pry TIME POLICE ARRIVED',7:19 PM
PART I PAGE IT]OF 4�
REPORT NO. EF54547 CASE# 25-126 OF COLLISION
01/04/25 19:14
OF CbLLI510N
NARRATIVE
CASE 25-126
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Saturday January 4th, 2024, at approximately 19:17, 1 responded to a 911 call regarding a two-
vehicle collision in the area of Garden Ave North and North 10th St within the City of Renton, King
County, Washington. The reporting party called 911 to report he was in a vehicle collision.
I arrived on scene and contacted the involved drivers who reported they were not injured and did not
appear to be injured. Unit one driver Ngema Ntensika (DOB:7.15.1985) reported he was traveling
south on Garden Ave North and was proceeded to take a left into the Lowes parking lot when he hit
unit two. Ngema indicated he had the green light.
Unit two driver Bhupindeer S. Hundal (DOB:5.21.1972) reported similar and consistent
circumstances. Unit one turned and hit him as he was driving north on Garden Ave North.
Both drivers had valid driver's licenses and valid insurance. Their vehicles were drivable and able to
drive away from the scene. I provided both drivers a SECTOR exchange of information form.
This concludes my involvement in this case.
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 B. Grozav #12489 on 1.05.2025 at 19:19 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF54547 CASE# ' 25-126 DATE AND TIME 01/04/25 19:14
OF COLLISION
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