HomeMy WebLinkAbout26-1227 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG91266oc� RA
COLLISION REPORT 1591971
CASE�# 26-1227 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`OENC'Y 4250 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TOTAL 1
TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 02 - 12 - 2026 1629 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
S GRADY WAY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 . FEET e S 8 W e SHATTUCKAVES
0 1 29
PEDAL- DAMAG THRESHOLD MET E
UNIT 01 VEHICLMOTORE PHON
❑ CYCLE ❑ YES NO ✓ Q $ 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP' 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYEs Nb YEs NO
8 LCEENSE# STATE SEX U MMDDYY+ —=— 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELM
USEET 9 CLASS 0 NATURE OF INJURIES 2
LICENSE, 3
1 O PI ATF# STATE V(N
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 7 3 33
12 0 0 VIN# VIN#
( FROM TO
VEH.YEAR MAKE BMW MODEL SUV STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 9 9 34
13 2 DAMAGE YES�NO� YES❑ NO
REGISTERED OWNER INFO (NEW] VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO IQ
4IN EFFECT &POLICY#v `LE CHARGE 5 36
Lec Ly YES❑NO❑ CITATION# 715❑ sTnNowc
MOTOR PEDAL- : PROPERTY DAM THR OLD MET PHONE
UNIT 02 Q ❑ PEDESTRIAN ❑ D:2066186623
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME MILLER FIRST NAME ANJENEE MIDDLE I L
INITIAL
STREET ❑ 37
17 ❑ 11522 SE 173RD ST CITY RENTON ST, WA ZIP 980555606 g
NEW ADDRESS
18 F] CDL IGNITION REQUIREO IGNTION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYES NO INTERLOCKYES N.Fj yES NOI
19 DRIVER' #
INJURY' NATURE OF INJURIES 4p
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CSX5347 TATE WA VIN# 4T1G11AK8PU831245 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR ZQ23 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO EAN HOLDINGS tLC 14002E21ST STSTE 1500 TULSAOK74134 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT &POLICY# t 9TOP
vewaE ❑ ,.III CITATION# CHARGE to BOTTOM
LEGnLLv YES N11
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG91266
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1227
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
wht sedan/unit 2 rear by unit 1 h/r
RTF Information/insurance only
Within the city limits of Renton/King/Wa I responded to a 2 vehicle hit and run crash at the
intersection of S Grady Way at Shattuck Ave S.
contacted the driver of unit 2, crying and upset, she told me that she was stopped for the red light
and opposing traffic when she was hit from behind by what she described as a dark colored, maybe
BMW SUV. She was not able to see the driver or license to the vehicle. That vehicle fled the area
without providing the required information based on RCW 46.52. Unit 2 did not complain of injury and
damages were minor and 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 2/17/2026
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-17-26 01:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/2/2026 1:15:53 PM
BADGE OR ID# Y517 ORI#' f WA0171300 TIME POLICE DISPATCHED, 4:31 PM TIME POLICE ARRIVED 4:34 PM
PART B 3 Da-3m5-,aa(R11ras) PAGE 27 OF 37
REPORT NO. EG91266 CASE# 26-1227 DATE AND TIME 02/12/26 16:29
OF COLLISION
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