HomeMy WebLinkAbout26-80 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG65743OLCERA
COLLISION REPORT 1591971
FIRE CASE#
26-80 2
INTERSTATE CITY STREET RESULTED ❑
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAI-AGENCY 4200 3
HIT&RUN ❑ CODING
COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 3❑ TOTAL#OF 2 OBJECT 4 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3n M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 01 - 03 - 2026 2235 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 11TH PL BLOCK NO. e 2500 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 1❑ 50 1.1 00 FEET e✓ S 8 W V GLENNWOOD AV NE
2 2 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 1 5 30
5 CAST NAME NONE FIRST NAME MIDDLE 31
INITIAL
STREET
NEW ADDRESS CITY I $EATTLE ST: ZIP: 2
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO 1/ INTERLOCKVEs No YES NO;1/
$❑ DCIENSE# SRVERSTTATE SEX.U MMDDYY' —=—ll 1 2 32
9❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 1 1HELM
USEET 9 CLASSY 1 NATURE OF INJURIES 2
LICENSE, CTU9151 7SAYGDEEXTF419928 3
10[9� PI ATF rt STATE WA yIN#
TRAILER STATE TRAILER STATE ROM To
11 0 0 PLATE# PLATE#
TRLR TRLR 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2026 MAKE TESL MODEL MODEL STYLE VEHICLE TOWED TO BUN TOWED By GOVT VEHICLE 0 O 34
DAMAGE YES NO YES_ NO
13� REGISTERED OWNER INFO ZAKYDAHHMOHAM4719S104THPLSEATTLEINA981782087 D:2063495936 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE NSURANCE CO 3 4
14 AMERICAN FAM 2114172f0354FPPAWA
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 5 36
Lemur yes[:]NO[:] CITATION# 7 0 80TTOM
15❑ sTnNowc s e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO �/ D:2534087083
16�
LAST NAME MARQUEZ FIRST NAME ARLYN MIDDLE'
INITIAL
STREET ❑
17 1❑ 139 GLENNWOOD AV NE CITY RENTON ST, WA ZIP 98056 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYEs NO INTERLOCK YES 0NO vEs No
19 DRIVERS STATE WA SEX F I D.O.B. 07 29 1993 E 39
LICENSE# MMDDYY -
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 1 USE CLASS 1 ❑
21 LICEN E LATEICNW2015 rare W/a vIN# 1 C4RJKDT3M8169067 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2021 MAKE JEEP MODEL GRAND STYLE 4p VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO KEVIN SNEED 1540942ND AVE S TUKWILA WA 98188 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO NONE
IN EFFECT &POLICY# 9TOP
veHiaE ❑ ,J—I CITATION11 CHARGE t080TTOM
L'EGn�LY YES N
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG65743
COLLISION REPORT III III III III III 111
1591972 CASE# 26-80
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 CLASS ----�
: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
Both Units 1 and 2 were parked behind 1141 Glennwood Av NE within a private parking lot off NE
11th PI across from 2597 NE 11 Pl. Unit 1 was parked illegally askew across an unmarked space
across a marked fire lane. Unit 2 backed up next to, on the driver side of Unit 1. Unit 2 scraped the
driver side of Unit 1 causing reportable non disabling driver side damage to Unit 1 and non disabling
non reportable front passenger side damage to Unit 2. No injuries. Unit 2 driver was proximate cause
of damage. Unit 1's side dash camera recorded incident.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 01-03-26 11:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 1/5/2026 1:07:13 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 10:38 PM TIME POLICE ARRIVED 10:45 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG65743 CASE# 26-80 DATE AND TIME 01/03/26 22:35
OF COLLISION
3 s
t
PAGE 3 OF 3