HomeMy WebLinkAbout26-1669 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG82965OLCERA
COLLISION REPORT 1591971
CASE�# 26-1669 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`NG 4150 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TOTAL 1
TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
GDLL.ISION'. 03 - 0? - 2026 1840 17 =.= S 8 W E OF IN M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 . FEET S 8 W e ON RAMP NB SR 167
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES V/NO Q $ 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET
NEW ADDRESS CITY'.. AUBURN ST ZIP 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NOW INTERLOCKYEs NO�/ YE5 NoF,/
8 LICIENSE# STATE SEX U MMDDYY' —=—VERS MOS. 1 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT ? HELM USEET 9 ;CLASS ,0 NATURE OF INJURIES 2
10 LI ENSE'' BHX6135 STATE WA VIN# 3RFREV3JW712501 3
TRAILER STATE TRAILER ,STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR TRLR 3 7 33
1 3 o VIN# vIN#
( FROM TO
2
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GO VT VEHICLE 9 9 34
13 3 2018 TOYT RAV4 SV DAMAGE YES YE NO
REGISTEREDOWNERINFO M/NHI.OW029THSTSE.7AUBURNWA98002 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE 2 3 4
IN EFFECT &POLICY# 4TOP
vEnic�E t 5 36
LEGALLY YES[:]NO❑ CITATION# CHARGE 7 o BOTTOM
15❑ STM ING I
7 e
rL� MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE' ❑ ❑ rwNFR YEs�/ NO D:3195219011
16�
LAST NAME PEDDAREDDIGARI FIRST NAME NARENDRA MIDDLEI N
INITIAL
STREET ❑
17 '❑ 10409 SE 174TH ST 2218 CITY RENTON ST, WA ZIP 98055 g 37
NEW ADDRESS
18� CDL IGNITION REQUIREC3 IGNTION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYEs NoNTERLOCKYES No YES No;�
19 DRIVER' # STATE WA SEK,M MMDDYY 06 01 1989 39
HELMET INJURY' NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 6 ❑
USE CLASS COMPLAINT OF RIB PAIN DECL AID
21 LICENSLATE E CSF4619 TATE WA VIN# 5YFB4MDE6RP082667 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR r RLR 43
UIN#. 'IN#.
VEH.YEAR 2024 MAKE TDYT MODEL COROLL STYLE $D I VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO�/ YES NO
REGISTERED OWNER INFO NARENORAPEDDAREDDIGARI10409SE174THST2218RENTONWA98055 D:1195219011 VEHICLE NO.2
SHADE IN DAMAGE$AREA
2 3 �4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 997632445
IN EFFECT &POLICY# t 9TOP 5
vewaE
YES� N CL J CITATION# CHARGE tO BOTTOM
VEHICLE
25 a 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG82965
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1669
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
Unit 1 traveling westbound along 400 block on S 43rd St approaching intersection of on ramp to NB
State Route 167.
Unit 2 was stopped legally at the light facing westbound at the same intersection. Unit 1 struck Unit 2,
glancing rear end collision, causing reportable non disabling front driver side damage to Unit 1 and
reportable non disabling rear passenger side damage to Unit 2. Unit 2 driver reported minor rib pain
from collision but otherwise was okay and declined aid on scene. Unit 1 driver did not stop and drove
away northbound on SR167. Unit 2 driver reported license plate of Unit 1 and also reported that he
would not be able to recognize Unit 1 driver if he saw him again.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 03-01-26 08:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT ORDISTDET DATED PLACESIGNED
APPROVED BY DATE
N/COLAS SANGDER 11350 3/5/2026 1:30:12 AM
BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:49 PM TIME POLICE ARRIVED 7:50 PM
PART B 3 Da-3m5-,aa(R11rls) PAGE 27 OF 37
REPORT NO. EG82965 CASE# 26-1669 DATE AND TIME 03/01/26 19:40
OF COLLISION
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