HomeMy WebLinkAbout23-6325 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6325 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 06 - 04 - 2023 1350 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 4TH PL BLOCK e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2064878457 0 3 30
6� LAST NAME HEMPHILL FIRSTNAME CHANELE MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 1300 S PUGET DR#515 CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CGK8999 sTArr WAurN# JHMGE8H31DC080070
10❑ PI ATE 14
TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2013 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 4 HOND FIT SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO MAHENDAR KUMAR 112 SW LANGSTONPL RENTON WA 98057 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 4070806FO847B 4
IN EFFECT &POLICY# 9TOP
VE—L'
15 1 5 36
LECALLvSTANDING YES❑NO❑ CITATION# CHARGE 10 BOTTOM
❑ 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063591196
16 a
LAST NAME KUMAR FIRST NAME NEELAM MIDDLE J
INITIAL
17 STREET ILAGSTON PL CITY' RENTON ST WA ZIP 98057 37
NEW ADOREs�' 612 SW
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19 STATEWASEXF .CB. 39
LICENSE# M .
20 ON DUTY❑ STATUS AIRBAG,2 RESTR 4 EJECT 1 H EET 2 NJAUR CLSSY 7 PAIN TO NECK AND BACK ❑F—NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BCX8091 TArE WA VIN# 41
2T3JFREV4HW574619 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE TOYT MODEL RAV4 STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NEELAM KUMAR 612 SWLAGSTON PL RENTON WA 98057 D:2063591196 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 40708FO847BIN STOP 5
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLYN
25 0(
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ROSEANNE HYNES 12612 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED67200
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6325
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KUMAR KRISTINA L
(I.P.ST FIRST,
ADDRESS&PHONE#
612 SW LANGSTON PL RENTON WA 98057 2069819892 SEXi F MMDOYyry 05 - 01 - 2003
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ �' 2 POS. 1 2 4 1 USE 2 CLASS 1
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# D O E4
SEX MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
ROSEANNE HYNES 06-04-23 06:37 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 6/5/2023 2:20:56 PM
BADGE OR ID# 12612 ORI# WA0171300 TIME POLICE DISPATCHED 2:13 PM TIME POLICE ARRIVED',2:14 PM
PART I PAGE IT]OF 4]
REPORT NO. ED67200 CASE# 23-6325 OF COLLISION
06/04/23 13:50
OF CbLLI510N
NARRATIVE
On 06/04/2023 at 1413 hours, I was in full patrol uniform and driving a marked Renton Police patrol
vehicle when I responded to S 4th PL and Rainier Ave S in the city of Renton, County of King, State
of Washington regarding a collision.
Upon arrival, I spoke with Chanele L. Hemphill who was the driver of a gray Honda Fit (WA LIC#
CGK8999). Hemphill told me in summary: She was driving west on S 4th PL crossing the intersection
at Rainier Ave S. She had the green light. As she drove through the intersection, another vehicle
(RAV4) struck her vehicle on the right side. Hemphill did not claim injury and declined medical
assistance. I did not observe visible injury upon her. I saw damage to the right side of her vehicle.
I spoke with Neelam J Kumar who was the driver of a black Toyota RAV4 (WA LIC# BCX8091).
Kumar told me in summary: She was driving south on Rainier Ave S and approaching the intersection
at S 4th PL. She was in the right lane, had the green light and was making a right turn onto S 4th PL
(attempting to turn westbound) when the Honda Fit drove in front of her in a westbound direction. Her
vehicle collided into the Honda Fit. Kumar complained of injury to her neck and back. She requested
medical assistance. I called for Renton Fire to respond and they arrived on scene. Kumar declined
medical transport. I did not observe visible injury upon her. I saw damage to the front left portion of
her vehicle.
I spoke with Kristina L. Kumar who was the front passenger in the Toyota RAV4. Kristina Kumar told
me in summary: She and her mother Neelam Kumar were making a westbound turn onto S 4th PL
from Rainier Ave S at the green light when the Honda Fit drove in front of them and their vehicles
collided. She did not claim injury. I did not see visible injury upon her.
Both drivers took photographs of the damage to their vehicles and exchanged insurance information.
No witnesses came forward at the scene. I have nothing further.
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: R. Hynes #12612 Date & Place: 06/04/2023 @ 1820 hrs Renton, WA
PAGE 3 OF 4
REPORT NO. ED67200 CASE# ' 23-6325 DATE AND TIME 06/04/23 13:50
OF COLLISION
Ali
i
N
Rainier Ave S `Not Drawn to Scale
Toyota RA'J4 + ,�
Honda Fit
i
Point of Impact
I
PAGE 4 OF 4