HomeMy WebLinkAbout23-8884 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c
COLLISION REP FIT 1591971
CASE 23-8884 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 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 08 - 1-- 2023 0830 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 5700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NILEAVENE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2535612634 N:2066294828 0 11
30
6� LAST NAME KINGSOLVER FIRSTNAME KELSEY MIDDLE W 1 1 2 31
INITIAL
STREET ❑ 12455 176TH AVE SE CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ 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 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C192335 sTArI WAurN# 1GCRWAEHXK2324372
----� TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2019 CHEV SILVER PK MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED By I GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO VITAL MECHANICAL SRVS 1420 MAPLE AVE SW RENTONWA 98057 D:2066294828 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ZURICHAMERICAN BAP659202300 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:8328779902
16 a
LAST NAME JOSHI FIRST NAME PURVI MIDDLE Y
INITIAL
17 STREET❑ NEW ADOREss❑' 5702 NE 7TH ST CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 11 26 _ 1986 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
❑ILICENSE 21❑ PLA E# CGW9310 TAre 41
WA VIN# 7SATGAEEOPF811191 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GoI
VEH —VEHICLE
YEAR 2023 MAKE TESL MODEL MODE!Y STYLE UT AMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 4659343 B2347AIN STOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL i o BOTTOM
0(
LY YES
25 ' a
=Kl
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88769
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8884
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SAWANT SAVAR N
(LAST FIRST,
ADDRESS&PHONE#
5702 NE 7TH ST RENTON WA 98059 SEX M MMDDYyry 03 - 17 - 2022
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 7 2 11 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On Friday, August 4, 2023 at 0837 hours, I was dispatched to a two-vehicle collision in the area of the
5700 block of NE 4th St.
The following occurred within the City of Renton, King County; Unit 1 - WA/ C19233S was being
driven by Kelsey Kingsolver and was driving westbound on NE 4th St in the 5700 block. Unit 2 - WA/
CGW9310 was driven by Purvi Joshi and was travelling southbound on Nile Ave NE through the
intersection.
Kelsey stated he was drinking coffee and driving westbound when he stated he was unable to avoid
colliding with Unit 2 in the intersection. The front passenger side bumper of Unit 1 collided with the
front driver side quarter panel of Unit 2. Kelsey stated his vehicle was equipped with a dash mounted
camera that captured the event. I provided Kelsey with my business and requested the video as soon
as possible.
Purvi stated the traffic control light was illuminated green and she drove southbound on Nile Ave NE
through the intersection of Nile Ave NE and NE 4th St., when she observed Unit 1 not stop and
ultimately struck the front driver side bumper causing significant damage.
Since I was unable to view the video, I was unable to determine which party was ultimately
responsible for the cause of the collision.
Both vehicles sustained damage, however, did not needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 08-04-23 10:30 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 8/13/2023 12:44:21 PM
BADGE OR ID# 12598 ORI#' WA0171300 TIME POLICE DISPATCHED 8:37 AM TIME POLICE ARRIVED',8:50 AM
PART I PAGE 2�OF❑
REPORT NO. ED88769 CASE# ' 23-8884 DATE AND TIME 08/04/23 08:30
OF COLLISION
POINT OF IMPACT
UNIT 2
\ NOT TO SCALE
UNIVOLVED MOTORISE UNIT 1
w NE 4th St
z
Q
.z
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