HomeMy WebLinkAbout26-2012 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG87380OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 26-2012 2
RESULTED 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#
eaCL s on' 03 - 13 - 2026 1609 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
SE 168TH ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e 126TH AVE SE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4253501799 0 1 30
6 LAST NAME COLSRUD FIRST NAME LINDA MIDDLE K 1 1 2 31
INITIAL
STREET ❑ 12606 SE 158TH ST CITY; RENTON ST WA ZIP 980584726 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCKYES NO YES ND
DRIVER # STATE WA SEXI F MMDDYY' 09 - 10 - 1962 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, C91473M STATE WA VIN#; 1B7GL23Y8TS508423 3
10 Fq I PI ATE#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IE.M To
TRLR zRLR. 5 1 33
12 3 0 VIN#' vIN#
FROM TO
VEH.YEAR 1996 MAKE DODG MODEL DAKPU STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO LINDA COLSRUD 12606 SE 158TH ST RENTON WA 980584726 D:4253501799 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 2 4
14 GE/CO TBD
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE t 5 36
Lemur YES[:]NO[:] CITATION# 70¢OTTOM
15❑ srnNowc s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2066833869
16�
LAST NAME NGUYEN FIRST NAME JUDY MIDDLE' N
INITIAL
17 F1 STREET ❑❑ 571 ROSAR/0 AVE NE CITY RENTON ST, yyq ZIP 980594553 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 38
INTERLOCKYEs ND INTERLOCK YES ay YEs NO
19 DRIVERS
MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN� ABV1060 rArE WA vIN 5J6RE4H35AL087046 41
PLATE I El
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23= TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2010 MAKE HOND MODEL CR_V STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO JUDYNGUYEN 571 ROSARIO AVE NE RENTON WA 980594553 D:2066833869 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO TRAVELERS 600927579 203 2
IN EFFECT &POLICY# Q
HICLE EEILe
L YES❑ NCOCITATION# CHARGE25 t
VE
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG87380
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2012
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
red/1 nb stop sign slv eb nothing
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash at the intersection of SE
168th St at 126th Ave SE.
I contacted the driver of unit 2 who told me she was eastbound on SE 168th St when unit 1 contacted
the driver side of her vehicle. She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. She told me she stopped for the stop sign
northbound at 168th and cleared traffic before proceeding. She told me she did not see unit 2 and
made contact with her while trying to cross the intersection. She did not complain of injury and
damages did not require a tow truck.
Information/Insurance 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 3/20/2026
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-20-26 06:47 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 1 3/20/2026 7:10:14 AM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:09 PM TIME POLICE ARRIVED i 4:10 PM
APART B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG87380 CASE# 26-2012 DATE AND TIME 03/13/2616:09
OF COLLISION
y
f
7'
y,
L
titi..3}
2 {
,t?trEc
r .
y
y
o
y► f
h �
e �v�4YY�V
t
n
a ,
a �
PAGE 3 OF 3