HomeMy WebLinkAbout26-00047 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG65475OLCERA
COLLISION REPORT 1591971
CASE# 26-00047 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 01 - 02 - 2026 1849 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NSET BLVD N BLOCK NO.
4a❑
MILE POST e
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e N 3RD ST
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2062347766 0 1 30
6 LAST NAME JACKSON FIRST NAME LEO MIDDLE F 1 1 2 31
INITIAL
STREET ] 8408 S 119TH ST
'.NEW ADDRESS CITY I SEATTLE ST: WA ZIP: 981784035 2
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES No%/ INTERLOCKYEs NO�/ YES NDF,/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 07 - 07 - 1965 1 2 32
-NJUR
9� ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CFY4875 STATE WA VIN#; 1J4GW68N8XC637320. 3
10 Fl I PI ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR TRLR. 5 1 7 33
12 3 5 VIN# vIN#
FROM TO
13 4 VEH.YEAR 1999 MAKE JEEP MODEL GRAND STYLE UT VEHICLE TOWED NO�iS46LIN Tv4 EBYMEYERS GOS❑VT EHICLE
Np 1 5 34
DAMAGE IIII._IIII
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE NONE 4
IN EFFECT &POLICY# <5,
TOPV""' CHARGE 36
LEGALLY YES❑NO❑ CITATION# 0TFOM15 srANowc 6
MOTOR PEDAL- PEDESTRIAN1:1 PROPERTYEl DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2065787725
16�
LAST NAME WILLIAMS FIRST NAME TALONYA MIDDLE M
INITIAL
STREET �/ ❑
17 ❑ 2826 NE 7TH ST CITY RENTON ST, WA ZIP 98059 q 37
NEW ADDRESS :
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES NO INTERLOCK YES DNo vEs NO
19 DRIVER'S STATE WA SEX F I D.O.B. 12 04 1988 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 7 HELMET 2 INJURY NATURE OF INJURIES 40
USE CLASS JAW AND NECK PAIN AND LOWER BACK PAIN
21 LICENSE CPX4750 TATE WA VIN# 1C3CCCDG6FN556827 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2Q15 MAKE CHRY MODEL 2QQ STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYERS
REGISTERED OWNER INFO TALONYA WILLIAMS 2826 NE 7TH ST RENTON WA 98059 D:2065787725 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 578.4507-C25.47
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ ,J—I CITATION# CHARGE t080TTOM
LEGALLY YES N 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG65475
COLLISION REPORT III III III III III 111
1591972 CASE# 26-00047
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE GLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CIASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
I was dispatched to a vehicle collision on 01/02/25 at the intersection of Sunset Blvd N and N 3rd St,
in city Renton, King County WA.
Unit 1 CFY4875 Driver: Leo F. Jackson (DOB 07/07/1965)
Unit 2 CPX4750 Driver: Talonya M. Williams (DOB 12/04/1988)
Upon arriving I spoke to Unit 2 who told me that she was traveling in the center lane heading South
on Sunset Blvd N when approaching N 3rd St intersection. She told me that the light turned green
and as she entered the intersection Unit 1 turned in front of her and she crashed into him.
I spoke to unit 1 who told me that he was traveling North on Sunset Blvd N when approaching N 3rd
St. He believed that his turn light was green to turn West onto N 3rd St off Sunset Blvd N and upon
entering the intersection he crashed into Unti 2.
Vehicle 1 caught on fire the fire department arrived on scene as was able to put the vehicle out.
Renton Fire arrived on scene to evaluate all personal. Unit 1 had no injuries and Unit 2 had
complaints of jaw and neck pain as well as back pain.
Information Exchange was given to both parties.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 01/02/2026, 2253 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 01-03-26 12:17 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 11312026 6:47:00 PM
BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:49 PM TIME POLICE ARRIVED i 6:52 PM
PAST B 3 Da-3m5—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG65475 CASE# 26-00047 DATE AND TIME 01/02/26 18:49
OF COLLISION
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