HomeMy WebLinkAbout26-1212 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG91268oc� RA
COLLISION REPORT 1591971
CASE# 26-1212 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL ANG 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ BJECT 1
TRIBAL TOTAL UNITS#OF 02 TRUCK 1 T 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
cQLLISION' 02 - 12 - 2026 0739 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
HARR/NGTON AVE NE
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 . FEET S 8 W e HARR/NGTON CIR NE
OF 3 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs V1 No D:2063356971 0 1 30
6 LAST NAME AVALOS FLORES FIRST NAME MARIA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 1911 HARRINGTON CIR NE CITY RENTON ST WA ZIP 980562322 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYE ND INTERLOCKvES NO YES No
8 DRIVERCENS # STATE WA SEX F MMDr YY' 08 - 07 - 1975 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET INJURY CLASS ',1 NAruRE of INJURIES 2
LICENSE, CUS9769 STATE WA VN# 4T1BE46K28U750901 3
10[9� PI ATP tI
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR TRLR 1 7 33
12 2 5 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE
13 2 2008 TOYT CAMRY DAMAGE YES ✓ YES❑ NO 3 7 34
REGISTERED OWNER INFO ALEJANDRO GOMEZ 19735 SE 128TH WAY ISSAQUAH WA 98027 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME SAME 3 4
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ STM ING
III MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE OWNER YES)/ NO D:2069405109
16�
LAST NAME HOLMES FIRST NAME BRITNEY MIDDLEI D
INITIAL
STREET ❑ 37
17 '❑ 2300 JEFFERSON AVE NE APT E11 CITY RENTON ST, WA ZIP 980568371
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs NG jNTERLOCKYEs No YEs NDi
19 DRIVER'S STATE WA SE}�,F D.O.B. 09 12 1989 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LLCANS E BWS6010 TATE WA VIN# 1 GYS4CKJ2HR348436 41
22❑ PLATE# STATE PAAILER
TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
TOWED BY GOV HI 44
VEH.YEAR 2017 MAKE CADI MODEL ESCALAD STYLE DAMIAGE TOWED�/ No BLIN BANKERS YES No�/
24
REGISTERED OWNER INFO BRITNEY HOLMES 2300 JEFFERSON AVE NE APT Ell RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO SAFECO H2600298
IN EFFECT &POLICY# 9TOP
VEHICLE LEGAIL,v ❑ N`,.ILJ
—I CITATION CHARGE 1060TTOM
25 YES s 7 e
--J
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. EG91268
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1212
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej 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
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 02-17-26 01:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 41212026 1:16:11 PM
BADGE OR ID# Y517 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 7:40 AM TIME POLICE ARRIVED 7:55 AM
PART B 3 Do-3m5-,ao(Burls) PAGE 27 OF 47
REPORT No.` EG91268 CASE# 26-1212 O COLLI COLLISION TIME
OF 02/12/26 07:39
COLLI
NARRATIVE
unit 1 wht sedan sb to wb unit 2 blk suv wb no/never been stop sign
RTF
Information/insurance only
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash at the intersection of
Harrington Ave Ne and Harrington Circ NE.
I arrived and found both vehicles near the entrance of a local school parking lot blocking the road and
driveway.
Unit 1 explained she was making a right turn from Harrington Crc to Harrington Ave when she was hit
by unit 2. She said unit 2 sped up before the impact. She did not complain of injury and damages did
not require a tow.
I contacted the driver of unit 2 who told me she was approaching the intersection at Harrington Crc
when unit 1 turned in front of her. She told me she believed this intersection was controlled by stop
signs at Harrington Crc. Unit 2 did not complain of injury and damages required a tow truck.
I checked with the city and determined this is an uncontrolled intersection with no history of stop
signs.
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
PAGE 3 OF 4
REPORT NO. EG91268 CASE# 26-1212 DATE AND TIME i 02/12/26 07:39
OF COLLISION
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