HomeMy WebLinkAbout25-80074 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-80074 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 11 - 1-- 2025 2042 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE 175TH ST BLOCK NO. e✓ 17500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 120TH LN SE
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2063764248 0 11
30
6� LAST NAME SINGH FIRSTNAME GURSEWAK MIDDLE 1 2 31
INITIAL
STREET ❑ 4135 SOUTH 130TH ST CITY TUKWILA ST WA Zjp, 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8❑ LDRIVER # STATE WA SEX'M MID
LOB 09 1— 03 — 1997 2 32
9 ON DUTY✓❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 D77606F sTATe WA V N#
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 5 33
12 2 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 2 2024 FORD F550 TT DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO TOWING ACTIVEPO BOX 75448 SEATTLE WA 98175 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 00593043.1 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
[:]NO❑ CITATION# 1 o BOTTOM
15❑ LECALLv STANDING YES8 7 6
UNIT VE IOOMOTR PEDAL- PROPE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY [:]I
DYES✓ NO OLDMET PHONE
16 a
LAST NAME KENT FIRST NAME MACKENZIE MIDDLE R
INITIAL
17❑ STREET ❑', 17305 121ST LN SEAPT VV202 CITY' RENTON ST WA ZIP 980585914 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19[—] LDI IVER # STATE WA ]SEX IF MMDDW 02 _ 14 1998 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CTX2081 TATe WA VIN1i JF2GTABC6MH368064
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2021 MAKE S(JB�4 MODEL CRO$S7- STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO✓ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE8 611 70 3 3 7IN STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGALLY YES N
OQ
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
DAV/D DOUGHERTY 13183 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG57449
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80074
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.
DAVID DOUGHERTY 11-22-25 11:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 1211112025 2:32:13 AM
BADGE OR ID# 13183 ORI# WA0171300 TIME POLICE DISPATCHED' 8:42 PM TIME POLICE ARRIVED',8:44 PM
PART I PAGE IT]OF 4�
REPORT NO. EG57449 CASE# 25-80074 OF COLLISION
11/22/25 20:42
OF CbLLI510N
NARRATIVE
Case 25-80074
1 was working as a fully uniformed City of Renton Police Officer in a fully marked City of Renton,
Police Car as unit#3R13. All events took place in the City of Renton, County of King, State of
Washington unless otherwise noted.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized. At the time of this call my body worn camera
was activated.
On 11/22/2025, at 2042 hours, I was dispatched to 17305 121st LN SE in front of Grammercy
Apartments leasing office, for a head on motor vehicle collision. I arrived at the intersection of SE
175th ST and 120th LN SE, and observed a white 2021, Subaru Crosstrek, WA plate CTX2081 that
had collided with a 2024 Ford F-550 Tow truck, WA plate D77606F. The tow truck had minimal
damage to the front right bumper. The Subaru was undrivable with heavy front-end damage and a
popped right front tire.
I spoke to the driver of the Subaru (Unit 2) who was identified as Mackenzie R Kent (DOB
02/14/1998). Mackenzie was very visibly upset and stated that she had collided with the tow truck and
her head hurt. Mackenzie, was travlling eastound towards the intersection. I spoke with the driver of
the tow truck (Unit 1) who was identified as Gursewak Singh (DOB 09/03/1997). Gursewak stated
that he was towing a vehicle and was driving out of 120th LN SE when he stated the Subaru was
travelling westbound down SE 175th ST and collided with the front of his tow truck. Gursewak also
stated that the Subaru did not have its headlights on.
The collision was caused by Unit-1 failing to yield to oncoming traffic at an intersection without a
traffic control device. I could not prove that Mackenzie was driving over the speed limit or that her
headlights were off. I did not issue citations to either driver due to the conflicting information. I
provided both drivers with exchange of information sheets. Mackenze was evaluated by Renton Fire
who determined that she did not need to go to the hospital for any injuries. Gene Myer Towing arrived
and towed Mackenzie's vehicle. Nothing further at this time.
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 D. Dougherty on 12/10/2025 at 2104 hours, In the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EG57449 CASE# ' 25-80074 DATE AND TIME 11/22/25 20:42
OF COLLISION
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