HomeMy WebLinkAbout25-4962 CE TRAFFicNREPORT NO. EF99995 5 127
COLLiSI®N REPORT 1591971
("7—
STATE FIRE CASE# 25-4962 2 6 6
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
VEHICLE ❑ LOCAL AGENCY] 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN TS#OF STRUCK JECT 28
01 ! TREE OR STUMP
RESERVATION: 2
3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
coislon 06 - 08 - 2025 0020 17 �.� S e W e OF 8 IN 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EASTVALLEYRD BLOCK NO.
8 3400 .�
4a❑ MILEPOST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET S 8 W OF SW 34TH ST
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YEs ,/No D:2534017464 30
6� LAST NAME SINGH FIRST NAME HARPREET r MIDDLE 1 2 31
INITIAL
STREET Z 25131 98TH PL S CITY KENT WA
NEW ADDRESS ST ZIP 98030 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1NTERLOCKYEs No�/ INTERLOCKYEs NOZ YES R No,/
8❑ DRIVERS
#
] ONDUTY� STATUS' AIRBAG 6 RES7R 4 EJECT 1 HELMET INJURY'6 NATURE OF INJURIES 2�
USE ;CLASS CHEST AND HEAD PAIN
3
LICENSE, CPV1717 srnr WA VIN# JM3KFBBL5R0516160
10� PIATF#
ILER11 3 5 PLARA TE# STATE PLATE# STATE ROM to
TRLR. TRLR. 1 5 33
12� VIN VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT,VEHICLE m 34
13 $ 2024 MAZD CX-5 DAMAGE YES ✓ NO � �MEYERS YES NO
REGISTERED OWNER INFO INC PAL AMERICANSECURITY900SW 1611431 STE 315 RENTON WA 98057 D:4254545011 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
a
14❑ LIABILITY INSURANCE INSURANCE CO GREAT AMERICAN ASSURANCE CAPF130979-01
IN EFFECT &POLICY# 9TOF
V"" CHARGE $ ❑ 36
..v YEs❑NO❑ CITATION# t0 BOTTOM
15❑ STAND NG 7 6
UNIT VEOH OGLE CYDAL ❑ PEDESTRIAN OWNERRTY � YES H OLD MET PHONE
16❑
LAST NAIVE ! FIRST NAME MIDDLE
'. INITIAL i
17 F] STREET "❑ CITY ST ZIP 37
NEW ADDRESS
18� IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
CDL :ERLOCKYEs NOF INTERLOCK YES Nb YES R NO
19� LICEVERS ENSE# STATE SEX MMDDYY' -=_� 39
20 ON DUTY STATUS AIRBAG RESTR EJECT HELMET INJURY NATURE OF INJURIES 40
USE CLASS
21 LICENPLATES# TATE' YIN# 41
42
22 FTRAILER TRAILER
PLATE# STATE PLATE# STATE
23 43
TRLR kRLR
VIN# IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY I GO HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE INSURANCE CO 3 4
IN EFFECT &POLICY# 4TOP 5
vEeia..E ❑ ITATION# CHARGE tOBOTTOM
LEGALLY YES `'L INC]J
25 a e
7NH
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
LAS SWAN 12965 WA0171300
3000-345-159 rR 11/1M PAGE 01 OF
PART A
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF99995
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4962
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 NATURE OF INJURIES
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 0,SS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. 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.
NICHOLAS SWAN 06-08-25 02:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 6/12/2025 3:47:25 AM
BADGE OR ID# 12965 ORI# WA0171300 TIME POLICE DISPATCHED 12:21 AM TIME POLICE ARRIVED i 12:26 AM
PART B 3000-345.160(Brute) PAGE 0 OF 47
E AND
REPORT NO.i EF99995 CASE# 25-4962 OF C COLLISION
06/08/25 00:20
OF Cb4Lfi510N
NARRATIVE
#25-4962
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 06/08/2025 at approximately 0020 hours 1 was dispatched to 3401 East Valley Rd in the city of
Renton, King County, WA, for a single vehicle collision with injuries.
Unit#1 was a white 2024 Mazda CX5 with WA LIC: CPV1717 (VIN: JM3KFBBL5R0516160)
I arrived on scene and found the vehicle unable to move with all airbags deployed and the driver still
sitting in the driver seat. Renton Fire was also on scene and was starting their evaluation of the
driver. The driver was complaining of pain and had a hard time communicating what hurt or what
happened.
Driver 1 of Unit 1, stated that he was traveling south on East Valley Rd when a car passed him from
behind. He stated he attempted to use his brakes but instead used the gas. He stated he was unsure
what happened then.
The vehicle was a security vehicle registered to Pal American Security. Insurance for the car was
provided and entered into SECTOR.
There were no additional cars on scene or evidence of damage to other vehicles. There was a tree on
the west side of the road that had the bark ripped off of it. It was evident that the vehicle hit the tree.
Officer Engel arrived on scene first and spoke with the driver as well. Officer Engel informed me that
the driver told him that the car turned on it's own and that he was unsure how that happened.
The vehicle was unable to be driven away from the accident location. Gene Meyer towing was
dispatched to remove the car. A tow impound form was provided to the tow company and one was
placed with the vehicle.
Officer Goodwin took pictures and uploaded them to Axon.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
the driver of unit 1 possibly having an unknown distraction that ultimately caused this collision.
If the driver of Unit#1 would have been paying attention to the road around them, they would not
have lost control of their vehicle and this collision would not have occurred.
This concludes my report.
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 Officer N. Swan #12965 on 06/08/2025 at 0253 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. E F99995 CASE# '', 25-4962 DATE AND TIME 06/08/25 00:20
OF COLLISION
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