HomeMy WebLinkAbout25-10029 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG50776OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-10029 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK TREE OR STUMP
RESERVATION I 1 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E
cDLLISION' 11 - 18 - 2025 1010 17 =.�� S W e OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
116TH AVE SE BLOCK NO. e 17100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �.� FEET e S 8 W e SEPETROVITSKYRD
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 30
g LAST NAME SINGH FIRST NAME SAHIB MIDDLE t 1 2 31
INITIAL
STREET ❑ 4222 SW 323RD ST CITY; FEDERAL WAY ST WA ZIP; 98023 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO%/ INTERLOCKYEs NO✓ YEs F,/ NO
g DCIENSE# STATE WA SEXI M MMDDYY' 04 - 12 - 1957 32
9� ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 NATURE of INJURIES 2
LICENSE, CLS7633 STATE WA VIN# JTLKE50EO91080785 3
10 F1 PI ATP tt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR TRLR 5 7 33
12� UIN#' VIN#
FROM TO
HICLE
13 4 VEH.YEAR 2009 MAKE TOYT MODEL SCION STYLE SD DAMAGE TOWED NO�iS46LIN T� WIZ�RS TOWING YES❑E NO✓ m 34
DAMAGE IIII._IIII
REGISTERED OWNER INFO SAHIBS/NCH 4222SW 323RD ST FEDERAL WAY WA 98023 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ UABILITYINSURANCE[%/] INSU&POLIRANCECY# CO STATE FARM 5270555 D2447C 3 4
IN EFFECT 9TOP
vEnic�E CHARGE 5
Lemur yes❑NO❑ CITATION# 36 t a 80TTOM
15❑ sTnNowc 7 e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN ✓ D:4253262499
VEHICLE CYCLE OWNER YES NO ✓
16❑
LAST NAME UNKNOWN FIRST NAME PENNY MIDDLE'
INITIAL
17 F1 STREET ❑
❑ 11526 SE PETROVITSKY RD CITY RENTON ST, WA ZIP 98056 37
NEW ADDRESS
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
CDL INTERLOCKYES NO INTERLOCK YEs No YES ND
19[ LICENSE# STATE SEX X M.00 B. —= � 39
HELMET INJURY'. NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASS ❑
21 PLATE# TATE VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
vemae ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NC
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
WA0171300
26
D.NELSON 12421
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG50776
COLLISION REPORT III III III III III 111
1591972 CASE# 25-10029
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ 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 CLASS ----�
: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
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.
D.NELSON 11-18-25 04:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1112012025 3:40:06 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 10:10 AM TIME POLICE ARRIVED i 10:10 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG50776 CASE# 25-10029 O OF COLLI 510N TIME 11/18/25 10:10
COLLISION
NARRATIVE
25-10029 ACC
On 11/18/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I added myself to a dispatched call of a single-vehicle collision near the intersection of
SE Petrovitsky Rd and 116th Ave SE Renton/King/WA.
Officer Nugent had located a 2009 Toyota Scion WA/CLS7633 that had gone off the roadway and
collided with some bushes. He checked on the driver and advised he believed it was a medical
emergency and started RRFA.
I arrived on scene as RRFA was evaluating the driver who had been identified by his WADL as Sahib
Singh DOB: 4/12/1957.
Sahib did not exhibit any obvious signs of intoxication; he initially had a dropping face and limited
movement to his limbs and was not able to communicate. Sahib slowly regained function to his limbs
and was able to communicate via a translator. He did not know where he had come from and how he
ended up in the bushes. RRFA transported Sahib to VMC for evaluation and treatment.
The Scion was stopped on the northwest corner of 116th Ave SE and Petrovitsky in the yard of 11526
SE Petrovitsky Rd. It had collided with small bushes and come to a stop. There was damage to the
front bumper of the Scion. Based on the angle of the vehicle it appeared as if it could have been
turning west from south 116th Ave or possibly driving west on SE Petrovitsky Rd.
Officer Catalan was able to speak with Sahib's son who advised that Sahib normally drops his
grandchildren off in the area.
The tenant in 11526 SE Petrovitsky Rd provided a phone number for his landlord and a name of
"Penny". I called the number and did not receive an answer.
Bankers Towing removed the Scion from the scene.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 11/18/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG50776 CASE# 25-10029 DATE AND TIME 11/18/2510:10
OF COLLISION
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PAGE 4 OF 4