HomeMy WebLinkAbout23-2931 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-2931 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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# ❑
cowsloN 03 - 1-- 2023 1730 17 ❑.= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 15100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e S ❑ E e 152ND AVE SE❑
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:5712018201 0 11
30
6❑ LAST NAME NARANG FIRSTNAME MONIKA MIDDLE 1 2 31
INITIAL
STREET ❑, 16231 SE 138TH PL CITY RENTON ST WA ZIP 980596837 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8 LDRIVER # STATE WA SEX'F MID
.O B 12 1— 23 — 1983 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9� PICENSE1I ATE 14 BQW9195 STATE WA V N# 2C4RC1H76JR194840
11[-; TRAILER STATE TRAILER STATE
11 5 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 5 0 VIN#' VIN#
:: FROM TO
VEH.YEAR 2018 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE 34
13 4 CHRY PACIFIC VN DAMAGE YES NOBS TOWING YES[:] No
✓
3 7
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 987761510 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 3AO111452 INATTENTIVE DRIVING I o Borrom
15❑ NDING 8
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT ' ❑✓ ❑ PEDESTRIAN ❑ ❑ D:2067418201
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME DIAZ PEREZ FIRST NAME DEIVY MIDDLE N
INITIAL
17 STREET IS❑' 17650 134TH AVE SE APT N301 CITY RENTON ST WA ZIP 980587839 � 37
NEW ADOREs
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 DRIVER'S STATE WA SEX M D.C.B. O6 _ O6 _ 2004 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS SORELEFTARM
❑LICENSE I 21❑ PLA E# CFG3706 TATE WA VIN1i JM1BJ225830132678 41
1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2003 MAKE MAZp MODEL PROTEG STYLE Sp VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DEIVY DIAZ PEREZ 17650134TH AVE SE APT N301 RENTONWA98058 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# IGQI
VE""LE YEs Nc❑ cIrATION# 3AO111451 CHARGE OP MOT VEH W/OUT INSURANCE
LEGALLY
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77]�NCY
26
E.CHANG 10065 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED47089
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2931
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NARANG MUNISH
(LAST FIRST,
ADDRESS&PHONE# D O.B.
16231 SE 138TH PL RENTON WA 98059 SEX M MMDDYyry 08 — 21 — 1952
PASSENGER Z WITNESS❑',UNIT# 1 SEAT
EA 6 AIRBAG 2 RESTR. 4 EJECT ? 1 HELM USEET 2 1 INJURY CLASS 1 NATURE OF INJURIES
POS.NAME
(LAST,FIRST,MIDDLE INITIAL) NARANG SAVITA
ADDRESS&PHONE# DOB
16231 SE 138TH PL RENTON WA 98059 SEX IF MMcrDYv, 01 _ 05 _ 1953
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 1 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
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'
UNIT 1 License plate: WA BQW9195 Driver: Narang, Monika (12-23-1983)
UNIT 2 License plate: WA CFG3706 Driver: Diaz Perez, Deivy N (06-06-
2004)
Both drivers were identified via WADL.
This is a summary of what occurred told to me by both drivers.
On 03-11-2023 at about 1730 hours, I was sent to a collision in the 15100 block of Maple Valley Hwy,
in the City of Renton, King County, Washington.
Upon arrival, the driver of unit 1 informed me that she made a right turn from 152nd Ave SE onto
Maple Valley Hwy westbound. When it was clear she changed lanes from lane 1 to lane 2. When
she changed lanes unit 2 hit her from the back. She told me that she did not see unit 2. She also
insists she was fully in lane 2 when the collision occurred. The driver of unit 1 admitted unit 2 was in
lane 2.
1 checked the damage to her vehicle and there was no damage to the rear of her vehicle. 1 saw there
was damage to the rear driver-side fender and tire.
The driver of unit 2 informed me of the following. He said he was driving westbound on Maple Valley
Hwy passing 152nd Ave SE in lane 2. Unit 1 turned from 152nd Ave Se and changed lanes into his
lane and they both collided in lane 2.
The driver of unit 1 was cited for inattention.
The driver of unit 2 was cited for no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 03-12-23 07:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 313112023 1:36:22 AM
BADGE OR ID# 10065 OR]#' WA0171300 TIME POLICE DISPATCHED 5:30 PM TIME POLICE ARRIVED 5:47 PM
PART I PAGE IT]OF 3�
REPORT NO. ED47089 CASE# 23-2931 DATE AND TIME 03/12/23 17:30
OF COLLISION
E VALLEY HWY
NOT TO SCALE
PAGE 3 OF