HomeMy WebLinkAbout24-2025 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-2025 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 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# ❑
COLLISION'. 02 - 1-— 2024 1115 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
4800 NE 4TH ST
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES NEET e S ❑ E e DUVALL AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:4256812227 0 11
30
6❑ LAST NAME HAGEL FIRSTNAME RANDY MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 14415 SE 143RD PL CITY RENTON ST WA 2jp, 980597000 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'M MID
LOB 07 1— O6 — 1961 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C47431C sTArI WAvIN# 2GTEK19YX71599308
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 1 3 33
12 3 5 VIN# VIN#
ROM TO
VEH.YEAR 2007 MAKE GMC MODEL NEW STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 9 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO RANDY HAGEL 14411 SE 143RD PL RENTON WA 98059 D:4256812227 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PEMPCO CA 0603985 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
LEGALLY YEs No clTAnoN# 4AO178115 FLD TO YIELD FROM DRIVEWAY OR o BorroM
15❑ STANDING 7 6
MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:7325436202
LAST NAME SREEDHARAN FIRST NAME SREEJITH MIDDLE
INITIAL
17 STREET IS❑' 740 WAPATO PL SE CITY RENTON ST WA ZIP 980595470 37
NEW ADDRES
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NoF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 24 1984 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLATE# BOW2765 TArE 41
WA VIN1 5YJ3E1E65KF512811 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE TESL MODEL MODELS STYLE SO VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SREEJITHSREEDHARAN 740 WAPATOPL SE RENTON WA 980595470 D:7325436202 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 4593353DO147IN 1 5VEHICLELLY ❑ CITATION# CHARGE
25 GQ
LEGA YES N`E]
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE53488
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2025
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MOHANAN DIWA
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
740 WAPATO PL SE RENTON WA 980595470 4258023006 SEXi F MMDDYyry 11 - 14 - 1985
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ E] 2 POS. 3 2 4 1 USE 2 CLASS I1
NAME
(LAST,FIRST,MIDDLE INITIAL) SREE✓ITH DIA
ADDRESS&PHONE# DOB
vv
740 WAPATO PL SE RENTON WA 98059 4258023006 SEX F MMDDYY 03 _ 23 _ 2023
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST 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 02-24-2024 at about 1115 hrs, I was sent to a collision which occurred in the 4800 block of NE 4th
St, Within the City Limits of Renton, King County, Washington.
Upon arrival I spoke with everyone involved and they both had the same account of the collision.
Unit 2 was traveling westbound in lane 1 and had their right turn signal on. Unit 1 was exiting a
driveway and thought unit 2 was going to turn into the driveway. Unit 1 looked to the right and saw
someone allowing them to make a left turn. Unit 1 pulled out of the driveway and struck unit 2.
Unit 1 did not yield right of way to unit 2 exiting the driveway which was a contributing factor in the
collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 02-24-24 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 2/24/2024 5:19:08 PM
BADGE OR ID# 10065 ORI# WA0171300 TIME POLICE DISPATCHED'; 11:15 AM TIME POLICE ARRIVED 11:24 AM
PART I PAGE IT]OF 3�
REPORT NO. EE53488 CASE# ' 24-2025 DATE AND TIME 02/24/24 11:15
OF COLLISION
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S ss, h
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