HomeMy WebLinkAbout26-3757 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-3757 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 05 - 1-- 2026 1234 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE 144TH ST BLOCK NO. e✓ 16000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ VV❑ 160THAVE SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066968140 0 11
30
6❑ LAST NAME LAKKAD FIRSTNAME SANJAY MIDDLE K 1 2 31
INITIAL
STREET ❑ 11939 SE 212TH PL CITY KENT ST WA 2jp, 98031 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 11 1- 25 - 1979 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
❑10 9❑ P1 aT�S� BXK9765 sTArI WWAvIN# 5TDDBRCHOMS022374 3
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2021 TOYT HIC�HLA MAKE MODEL STYLE UT VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE 7 3 34
13 4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 4622-11.74.99 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE, ❑ ❑ OWNER ❑ YEs NO ,/ D:2066376843 N:4254787191
16 2
LAST NAME CASOVERDE VALLE FIRST NAME JOSE MIDDLE JE
INITIAL
17❑ STREET ❑' 510 75TH ST SE UNIT 201 CITY EVERETT ST' WA ZIP 98203 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No❑ INTERLOCK YYEEsI❑NoF YES❑NO❑
19[ DIVE STATE WA SEX M Mr D.C.B. 07 08 _ 1993 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE D14685F TAre WA VIN1i 54DBDJ187LS804271
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE CHEV MODEL 3500 STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SOUTHERN BY DESIGN 1692148TH AVE W LYNNWOOD WA 98037 D:4254787191 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE I PORGY#E CO CHOICE 6032992-27IN I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH07263
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3757
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.
KEITH PETTY 05-15-26 02:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 5/30/2026 4:38:40 PM
BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED 12:34 PM TIME POLICE ARRIVED',12:46 PM
PART I PAGE IT]OF 4�
REPORT NO. EH07263 CASE# 26-3757 OF COLLISION
05/15/26 12:34
OF CbLLI510N
NARRATIVE
26-3757
On 05/15/2026 at approximately 1234 hours, I was dispatched the intersection of SE 144th St and
160th Ave SE in the City of Renton, County of King, State of Washington for an accident with no
injuries.
Unit 1- white Toyota Highlander (BXK9765/WA) driven by Sanjay Keshavji Lakkad (DOB 11-25-1979
Unit 2 white 2020 Chevy 3500 (D14685F/WA) registered to Southern Design LLC, driven by Jose E
Casoverde-Valle (DOB 07-08-1993) All parties were identified by their WADL.
Unit 1 stated he was waiting at the intersection of SE 114th ST and 160th Ave SE attempting to head
north, he pulled too far into the intersection and did not see unit 2 approaching. Unit 2 collided into the
front section, ripping the bumper off unit 1. The damage was estimated to be over $1000.
Unit 2 stated through language line that he was heading east on SE 144th ST. When he approached
160th AVE SE, unit 1 pulled to far into the intersection causing him to collide into the front of unit 1.
Unit 2 only had minor damage to the side of the vehicle.
I provided an exchange of information for both parties.
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: 05/15/26t 1354 hours, Place: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EH07263 CASE# ' 26-3757 DATE AND TIME 05/15/26 12:34
OF COLLISION
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PAGE 4 OF 4