HomeMy WebLinkAbout22-13338 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED15565 170
27
COLLISION REP FIT 1591971
CASE 22-13338 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&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# ❑
COLLISION.. 12 - 1-— 2022 1355 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HARDIE AVE SW BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET e S B W e SW 5TH PL
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063072700 0 11
30
6� LAST NAME GUEVARA FIRSTNAME MARIA MIDDLE A 1 2 31
INITIAL
STREET ❑ 5602 S A VON ST TTLE WA
NEW ADDRESS ST zlp', 96178 2 CITY SEA
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICENSE# STATE WA SEX'F MMDDYY 06 - 13 - 1985 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ LICENS P1 ATE 14 CCK2851 sTAr WAv N# KNDJP3A59E7023206
5 TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 2 $ VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2014 KIA SOUL DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO MARIA GUEVARA 5602 S AVON ST SEATTLE WA 98178 D:2063072700 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 4
14 LIABILITY INSURANCE STATE FARM 510 9943-C21.47
LI EFFECT I SUR N# TOPVEHlcl.e CHARGE <1�3
OTTOM 5 36
LEGALLv YES No CITATION# 2A0726803 FAIL YIELD PRIVATE RD MOTOR $
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN
16 a PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065787676
LAST NAME SATNAM SINGH FIRST NAME MINHAS MIDDLE
INITIAL
17 STREET I❑ s❑' 24620 RUSSELL RD APT L 105 CITY KENT ST WA ZIP 98032 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YYEESI I I NOF YES
t l No�
19 D IVEW # STATE WA SEX M M.C.B. 09 _ 17 1987 39
FN—ATURE OF INJURIES
20� ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 WEB MEET 2 LAU SY ] COMPLAINT OF BACK PAIN ❑ 40
❑21❑ PLATE# 41
CAR6621 TArE WA VIN1 1HGCV1F1XLA048061 1
42
22❑ PLATILER E# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MINHAS SATNAM SINGH 24620 RUSSELL RD APT L 105 KENTWA 98032 D:2065787676 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSURANCE
#E CO ENCOMPASS 15130IN I STOP 5
VETILE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 Q.
7NE
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ON 12327 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED15565
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13338
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.
T.NELSON 12-17-22 03:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 12/18/2022 4:00:18 AM
BADGE OR ID# 12327 ORI# WA0171300 TIME POLICE DISPATCHED; 2:04 Pry] TIME POLICE ARRIVED',Y:05 PM
PART I PAGE IT]OF 4�
REPORT NO. ED15565 CASE# 22-13338 OF COLLISION
12/17/22 13:55
OF CbLLI510N
NARRATIVE
22-13338
On 12-17-2022 at approximately 1404 hours I was dispatched to a collision that occurred in the 400
block of Hardie AVE SW, in the City of Renton, County of King, WA.
I arrived and located the involved vehicles. Unit 1 had sustained significant front-end damage. Unit 2
had sustained significant passenger side damage around the rear wheel well and had a rear
passenger side flat tire.
I contacted the driver of unit 1, Guevara. Guevara advised that she attempted to make a left turn from
the private parking lot of Fred Meyer at 365 Renton Center Way SW, in the City of Renton, County of
King, WA to travel south on Hardie AVE SW. Guevara said she did not see unit 2 who was travelling
south on Hardie AVE SW when the front of unit 1 struck the rear passenger side of unit 2.
The driver of unit 2, Singh, relayed a similar account of the incident. Singh confirmed he was
travelling south on Hardie AVE SW when unit 2 struck his vehicle. The Renton Fire Authority
responded to evaluate Singh due to him complaining of back pain. Singh was cleared medically by
fire.
The damage was consistent with what both drivers advised. Based on my evaluation of the collision, I
believe unit 1's failure to yield the right of way to unit 1 was the proximate cause of the collision.
I provided both drivers with an exchange of information. I advised Guevara that she would be cited for
failing to yield the right of way to unit 2.
Guevara was cited for violating 46.61.205.
1 certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by T. Nelson #12327 on 12-17-2022 1447 hours Renton, WA
PAGE 3 OF 4
REPORT NO.! ED15565 CASE# ' 22-13338 DATE AND TIME 12/17/22 13:55
OF COLLISION
PAGE 4 OF 4