HomeMy WebLinkAbout25-8875 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 25-8875 z
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 1 TOTAL#OF OBJECT 1 0 4 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cawsloN 10 - 13 - 2025 1931 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 17600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FMILES N EET e S B E e SEPETROVITSKYRD
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:9196093870 30
5� LAST NAME GILMORE FIRSTNAME BRITTANY MIDDLE H 1 1 2 31
INITIAL
STREET ❑1 18920 131 ST PL SE CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES R NoLl
8❑ D
RI
VERS STATE WA SEX'F MM DAY' 10 — 17 — 1994 32
9 ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATNES# NA09596 sTAr WAvN# 1GKS2EEF4ER178224
0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13 3 2014 GMC YUCON UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO BRITTANY GILMORE 18920131ST PL SE RENTON WA 98058 D:9196093870 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO USAA 052912236G 4
IN EFFECT &POLICY# 9TOP
VEHICLE
15❑ PEDAL-
5 35
LECALLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE El
❑ ❑ OWNER ❑ YES NO ,/ D:2067861984
16 a
LAST NAME JASSAL FIRST NAME JATIN MIDDLE
INITIAL
17 NEW ADDRE— 24010 1STREET 34TH CT SE CITY KENT ST WA ZIP 98042 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVE #
ON DUTY STATUS 1 AIRBAG RESTR EJECT 2 HELMET 2 INJURY 6 NATURE OF INJURIES 40
USE CLASS LEFT KNEE,LEFT CHEST
❑21❑ TArE 41
LICENSE VIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ,.❑ I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 4 9 KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG39003
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8875
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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.
KEITH PETTY 10-13-25 11:28 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1011912025 1:48:27 AM
BADGE OR ID# 1Y809 OR]# WA0171300 TIME POLICE DISPATCHED 7:32 Pry TIME POLICE ARRIVED',7:33 PM
PART I PAGE IT]OF 5�
REPORT NO. EG39003 CASE# 25-8875 OF COLLISION
10/13/25 19:31
OF CbLLI510N
NARRATIVE
25-8875
On 10/13/2025 at approximately 1933 hours, I was dispatched to Subway located at 17633 108th Ave
SE in the City of Renton, County of King, State of Washington for a vehicle vs pedestrian accident.
Upon arrival I viewed a male laying on his back leaning against the entrance curb. The male was
identified as Jatin Jassal (DOB 11/10/1999) by his WAID.
Jatin did not speak much English but did say he was able to breath and felt most of the pain in his left
knee.
Jatin's friend, Sonpreet Singh (DOB 03/04/1989) was translating for him. Sonpreet stated that Jatin
was riding his electric bicycle south on the sidewalk along 108th Ave SE. As Jatin was about to pass
the entrance to the Subway a vehicle turned into the parking lot in front of him. Jatin was unable to
stop and hit the passenger side of the vehicle. The handlebar jammed into Jatin's left chest and Jatin
fell to the ground slamming his left knee into the concrete.
Jatin had on dark colored clothing with no reflective gear or helmet on. There was a light attached to
the front of the bike, but it is unknown if the light was on.
Brittany Hatt Gilmore (DOB 10/17/1994) was the driver of the red 2014 GMC Yukon (NA09596/WA)
VI N/1 GKS2EEF4ER 178224, that had been involved in the collision. Brittany was identified by her
WADL.
Brittany stated that she was heading south on 108th Ave SE when she turned right to enter the
Subway parking lot. She said she did not see anyone prior to turning. Brittany heard the collision and
stopped to check on what happened. When she exited her vehicle, she saw Jatin laying on the
ground and called 911.
RRFA responded to the scene and transported Jatin to the hospital for further evaluation.
I took pictures of the damage on the GMC and the electric bike and uploaded them to AXON.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"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: 10/13/25t 1937 hours, Place: Renton, King County, WA
PAGE 3 OF 5
REPORT NO. EG39003 CASE# 25-8875 OF COLLISION
10/13/25 19:31
OF CbLLI510N
NARRATIVE
PAGE 4 OF 5
REPORT NO. EG39003 CASE# ' 25-8875 DATE AND TIME 10/13/25 19:31
OF COLLISION
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