HomeMy WebLinkAbout26-303 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG70430OLCERA
COLLISION REPORT 1591971
❑ 0✓ FIRERES ED I
CASE#I 26-303 2
INTERSTATE CITY STREET FIRE STOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 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#
DATE OF N E IN eDLLISION' 01 - 11 - 2026 1423 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
NE44THST MILE POST
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �. FEET e S 8 W e LAKE WASHINGTON BLVD
1 9 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2064231860 1 9 30
5 LAST NAME MAGOMEDOV FIRST NAME MAGOMED MIDDLE t 1 2 31
INITIAL
STREET ] 3305 NE 182ND ST CITY; LAKE FOREST PARK WA
NEW ADDRESS ST ZIP: 981554121 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYEs ll-✓ YES No Z
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 12 — 19 — 1998 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CMR2009 STATE WA VIN# 2C3CDXBG6NH160962 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
rRLR 7 3 33
12 2 5 TVINRLRRLR vIN#
FROM TO
VERYEAR 2022 MAKE DODG MODEL CHARG STYLE SD VEHICLE TOWED TO BLIN TOWED By GES VEHICLE g 3 34
13� DAMAGE YES�NO ✓� YES❑ NO✓
REGISTERED OWNER INFO HERTZ VEHICLES LLC 18625 DES MOINES MEMORIAL DR SEA TAC WA 98148 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE NSURANCE CO 3 4
14 GE/CO 6221657148
IN EFFECT &POLICY# 4TOP
V""' CHARGE t 5 36
LEGALLY YES❑NO❑ CITATION# 7 0 80TTOM
15❑ STANDING s e
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES NO �/ D:2063965538
16�
LAST NAME FERREIRA CELIS FIRST NAME ISABELLA MIDDLE C
INITIAL
17 F1 STREET ❑❑ 7912 110TH AVE SE APT 703 CITY NEWCASTLE ST, WA ZIP 980561675 4 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES ND✓ INTERLOCK YES ye ✓ vEs NO I✓
19� DRIVER'S '
MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJURY
1 NATURE OF INJURIES 40
21 LICENSE CRE7885 raTE WA vIN# 19XFC2F61KE214773 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2019 MAKE HOND MODEL CIVIC STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24� DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO LISSELOTCELIS7912110THAVESEAPT703 NEWCASTLE WA 98056 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE[Z INSURANCE CO INTEGON NATIONAL INSURANCE COMPANY 2025875386
IN EFFECT &POLICY# 9TOP
LY—ve ❑ ,J—I CITATION# CHARGE t080TTOM
LEGALL YES N`[
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG70430
COLLISION REPORT III III III III III 111
1591972 CASE# 26-303
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) CELIS LISSELOT D
ADDRESS&PHONE# D O B
7912 110TH AVE SE APT 703 NEWCASTLE WA 980561675 2063965538 SEXi F MM DDYVYY 04 IT
14 — 1983
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NLASS NATURE OF INJURIES
2 POS. 3 2 4 1 USE 2 CLASS ;1 -- —�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE O'SS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
On 01-12-2026 at about 1423 hours, I was sent to a collision which occurred at NE 44th St and Lake
Washington Blvd NE roundabout, with in the City of Renton, King County, Washington.
Both drivers were identified via their WADL.
Driver of unit 2 said she was driving southbound on Lake Washington Blvd NE. She entered the
roundabout and ended up in lane 2 on the southside of the roundabout when the collision occurred.
Driver of unit 1 said he was driving eastbound on NE 44th St and entered the roundabout. He was in
lane 1 and on the south side of the roundabout when the collision occurred.
Both drivers said the other driver was at fault and the other vehicle came into their lane and hit them.
They both said they were going to exit on the east side of the roundabout. I was not able to
determine who caused the collision.
There are no cameras in this area. They both did not have a dash camera.
Nobody was injured 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 01-14-26 02:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1/20/2026 1:27:48 PM
BADGE OR ID# 10065 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:23 PM TIME POLICE ARRIVED i 2:43 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG70430 CASE# 26-303 DATE AND TIME 01/11/26 14:23
OF COLLISION
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