HomeMy WebLinkAbout23-3948 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. ED49413 170
27
COLLISION REP FIT 1591971
CASE 23-3948 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 04 - 1-- 2023 1736 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
OAKSDALE AVE SW BLOCK NO. e✓ 4200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET MILES e S B W e S 180TH ST
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2064340663 0 11
30
6� LAST NAME CHETTY FIRSTNAME AMLESH MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 15814 SE FA/RWOOD BLVD CITY RENTON ST WA Zjp, 98058 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BZR1831 sTArI WAurN# 4T3E6RFV9MU042583
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2021 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 TOYT RAV4 SW DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO FIRST NATIONAL H2519432 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2534869886
16 a
LAST NAME FL ORES FIRST NAME ANDREA MIDDLE M
INITIAL
17❑ STREET ❑' 7809 148TH STREET CT E CITY PUYALLUP ST' WA ZIP 98375 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] D IVEW # STATE WA SEX F M .C... 04 26 _ 1993 El 39
CENS —NATURE OF INJURIES
H USE CLASS
NJAURSY SORE LOW BACK DECLINED AID
40
20 F ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7
21❑ LICENSE I BAJ3135 TAre I WA vIN# JHMGD38407SO42838
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH YEAR 2007 MAKE HOND MODEL FIT STYLE 4y DAMAGE TOWED NOO✓ BLIN TOWED BY OV HYES NO 1/ 44
24❑ YES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 4445-96-85-40IN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 4553 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED49413
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3948
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
POS. 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'
On 04/07/2023 at approximately 1739 hours, I was dispatched to a two vehicle non injury collision in
the 4200 block of Oaksdale AVE SW, in the City of Renton, County of King. The vehicles had pulled
off the roadway and were waiting in a parking lot for contact.
I spoke with the driver of Unit 1, who identified herself as Chetty Amlesh with a WA State license who
and she conveyed the following. While driving SB in the middle lane in the 4200 block of Oaksdale
AVE SW she turned her left turn signal and attempted to make a left lane change into the left turn
lane as vehicles had allowed her to do so. While making the lane change she said she collided with
Unit 2. Amlesh was not insured during the collision.
I spoke withe the driver of Unit, who identified herself as Andrea Flores with a WA State license and
she conveyed the following. While driving in the left turn lane Unit 1 changed lanes colliding with the
passenger side door of her vehicle. She said her back was a little sore but she declined aid.
The damage on Unit 1 was to the driver side front left bumper. The damage to Unit 2 was to the
passenger side rear door. This was consistent with both driver's statements. There were no
witnesses to the collision. The damage was not significant and appeared to have occurred at lower
speeds.
I did not issue a citation to Amlesh for making an unsafe lane change.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 04-07-23 07:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 4/7/2023 7:50:00 PM
BADGE OR ID# 4553 ORI# WA0171300 TIME POLICE DISPATCHED 5:39 PM TIME POLICE ARRIVED 5:44 PM
PART I PAGE IT]OF
REPORT NO. ED49413 CASE# ' 23-3948 DATE AND TIME 04/07/23 17:36
OF COLLISION
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