HomeMy WebLinkAbout26-1089 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 26-1089 2
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4'I00 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-— 2026 1540 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DUVALL AVE NE BLOCK NO. e✓ 1075
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:9073603783 30
6� LAST NAME EVANS FIRSTNAME LELINA MIDDLE M 1 1 2 31
INITIAL
STREET El 650 DUVALL AVE NE #U1421 CITY RENTON ST I WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO INTERLOCKYEs NO YES NO
❑ DRIVER'S' STATE AK SEX'F MM DAY' 08 - O6 - 1997 �32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET I IINLJAURY 0 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 CMW4601 STATE WA VIN# KM8R7DGE8RU761551
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ vIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 A 2024 HYUN PALISA DAMAGE YES NO ✓ YES❑ NO✓
REGISTERED OWNER INFO DA'SHAYALEXANDER 1200 HARRINGTON AVENE RENTON WA 98056 D:9076061836 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE INSURANCE CO SAME SAME 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLv YES NO CITATION# 10 BOTTOM
15❑ IAINDIING�Ul
NIT U2 VEHIMOTCLE ❑ CYCLE ❑ PEDESTRIAN PROPERTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME ALEXANDER FIRST NAME KAYSON MIDDLE A
INITIAL
17❑ STREET ❑', 1200 HARRINGTON AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK vEs I I NOF YES t l NO❑
19 F] LDI IVER # STATE SEX M M D.O.B. 10 _ 15 _ 2014 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET I INJURY 7 NATURE OF INJURIES 40
USE CLASS LEFTFOOT
❑21❑ LICENSE TATE VIN1 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 1 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`L J
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG82506
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1089
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-06-26 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOSS 1953 3/3/2026 9:59:23 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 3:43 PM TIME POLICE ARRIVED',3:47 PM
PART I PAGE IT]OF 4�
REPORT NO. EG82506 CASE# 26-1089 OF COLLISION
02/06/26 15:40
OF CbLLI510N
NARRATIVE
pl loadingleft foot
RTF
Within the city limits of Renton/King/Wa I responded to a car v ped at 1075 Duvall Ave NE with Fire
enroute.
I arrived and located a Ped/Kayson in the south end of the elementary school parent/student loading
zone. The Ped was sitting on a bulkhead with his left shoe off and an ice pack on his foot. He told
me his foot was run over. He told me it had a burning pain and that he was already feeling better
from when it happened.
I contacted the driver of unit 1 who told me she was picking up several kids, Kayson included. She
said she thought everyone was loaded up and started to pull forward slowly and ran over Kaysons
foot while he was stepping in with his right foot and his left foot was struck. Kayson was getting in the
back passenger side of the vehicle. There was no other contact to the vehicle or Kayson body than
the tire and his left foot.
Renton Fire arrived and checked Kayson. He was cleared by Fire on scene.
Kaysons mom arrived. I provided a copy of the info exchange to both unit 1 and mom. No additional
questions.
Information only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 2/6/2026
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: MOVING FORWARD
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EG82506 CASE# ' 26-1089 DATE AND TIME 02/06/26 15:40
OF COLLISION
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