HomeMy WebLinkAbout26-2323 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG90693oc� RA
COLLISION REPORT 1591971
CASE# 26-2323 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 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#
eDCL s o v' 03 - 25 - 2026 1007 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
WELLS AVE S BLOCK NO. e 221 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4256265026 0 1 30
5 LAST NAME MATTSON FIRST NAME NICOLE MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 919 FIELD AVE NE CITY; RENTON ST I WA Zlp; 980590000 2
NEW ADDRESS
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCK YEs No INTERLOCKVEs Nb YES ND
8 DRIVER # STATE WA SEXI F MMDDYY' 08 - 23 - 2003 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RE
4 EJECT 1 N USE CLASSY 1 [NATURE of INJURIES 2
10 at ENSttEI BZD6490 STATE WA VINs 2T1BR32E76C574974 3
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# 11ROM To
TRLR rRLR 7 1 33
12 2 5 VIN#' VIN#
FROM TO
LE
13 2 VEH.YEAR 2006 MAKE TOy. MODEL COROL STYLE VEHICLE TO YED NOIyS46LIN diW9YMEYER YESr`-IVT ENp 1 5 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO KJELL MATTSON 919 FIELD AVE NE RENTON WA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 4
14 PEa4co ca 12ososs
IN EFFECT &POLICY# 9TOP
ic CHARGE 5 36
Lemur yes❑NO❑ CITATION# HARE t a 80TTOM
15❑ STANDING I s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:5416212892
16�
LAST NAME TAYLOR IV FIRST NAME CHARLES MIDDLE E
INITIAL
17 F1 STREET ❑❑ 501 S 318TH PL CITY FEDERAL WAY ST, yyq ZIP 980035221 37
NEW ADDRESS
18❑ CDL IGNITION REt�UIRED fGN1710N PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES NO INTERLOCK YES No YES NO
19 DRIVER'S STATE WA SEX M D.Os. 03 09 1982 39
LICENSE# MMD6YY —
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E C63928X rare WA vIN# 3TYRX5GN2MT026432 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2021 MAKE TDYT MODEL TA COMA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO CHARLES TAYLOR 501 S318TH PL FEDERAL WAY WA 980035221 D:5416212892 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE[Z INSURANCE CO PROGRESSIVE 940614960
IN EFFECT &POLICY# 9TOP
veG— ❑ ,J—I CITATION# CHARGE to BOTTOM
LEA��y YES N`[
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF 11
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG90693
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2323
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 CLASS 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
gry rt hit slv sb
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash near the 221 block of Wells
Ave S.
I contacted the driver of unit 2 who told me he was southbound on Wells Ave S when unit 1 pulled out
into the roadway contacting his vehicle on the passenger side. He did not complain of injury and
damages did not require a tow truck.
I contacted the driver of unit 1 who told me she was attempting to merge into traffic and her view was
obstructed by parked vehicles on the west side of Wells Ave S. She proceeded and did not see unit 2
contacting him in the side. She did not complain of injury and damages did 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 3/25/2026
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-25-26 11:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 1 41112026 12:14:59 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 10:08 AM TIME POLICE ARRIVED i 10:12 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG90693 CASE# 26-2323 DATE AND TIME 03/25/2610:07
OF COLLISION
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