HomeMy WebLinkAbout26-1793 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG91272OLCERA
COLLISION REPORT 1591971
CASE# 26-1793 2
INTERSTATE CITY STREET❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL AGENCY 4100 3
CODING
COUNTY RD PRIVATE WAY ❑✓ INVOLVED 2❑ 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
coLLlsfoN' 02 - 14 - 2026 0830 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 4TH ST BLOCK NO, e 3904 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 3501.1 00 FEET e✓ S 8 W V UNION AVE NE
0 1 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE CYCLE' YES NO �/ D:4258911282 30
6 LAST NAME SCHAEFER FIRST NAME NICHOLAS MIDDLE B 1 1 2 31
INITIAL
STREET 0 3305 104TH AVE NE CITY LAKE STEVENS ST I WA ZIP 98258 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO%/ INTERLOCKYEs Nt �/ YES D NOW
8 LICIENSE#RVER' STATE WA SEx MMDO orYY' 10 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET
2 CLASS 0 NAruRE of INJURIES 2
LICENSE 3
10� PI ATF rt UNKOWN srarE WA vN
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# FROM TO
rRLR TRLR 1 5 33
12 VIN# VIN#
( FROM TO
I
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 9 UNKN UNKNO DAMAGE YES NO� YEs H 3 7 34
REGISTERED OWNER INFO NICHOLAS SCHAEFER 3305104TH AVE NE LAKE STEVENS WA 98258 D:4258911282 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 PROGRESSIVE 954371.1
IN EFFECT &POLICY# <DQ,
VEHICLE CHARGE 36
YES❑NO❑ CITATION#
15❑ sTnNowc s 7 e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT 0'� PEDESTRIAN Q✓ D:2063047108
VEHICLE CYCLE' nWNFR
16�
LAST NAME DEL REAL FIRST NAME ELIDIA MIDDLE'
INITIAL
STREET ❑
17 906 EMERALD ST CITY M►LTON ST, WA ZIP 98354 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38
INTERLOCKYES ND INTERLOCK YES NO YEs NO
19 DRIVER'S STATE WA SEY F I DOJB. 11 15 1943 ❑ 39
LICENSE# MMD?YY —
20❑1 HELMET INJURY' NATURE OF INJURIES 3 40
ON DUTY STATUS 3 AIRBAG RESTR EJECT USE 2 CLASS S BROKEN HIP AND SCRAPES TO RIGHT ARM ❑
21 1
PLATE# rarE vIN# 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
GOV H 44
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY I
24 1 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
1-ICLe ❑ ,[J—I CITATION# CHARGE
LEEAI tO BOTTOM
L YES N`
25= Is 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
WA0171300
26
D.NELSON 12421
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG91272
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1793
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.
D.NELSON 03-06-26 03:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 41212026 1:20:19 PM
BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 10:10 AM TIME POLICE ARRIVED 10:10 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG91272 CASE# 26-1793 O COLLI COLLISION TIME
OF 02/14/26 09:30
COLLI
NARRATIVE
26-1793 ACCINJ
On 3/6/2026 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of an injury collision that had occurred prior in front of
3904 NE 4th St Renton/King/WA. Maria Gutierrez was calling on behalf of her mother, Elidia Del Real
DOB: 11/15/1943.
1 called Maria who explained that on February 14th at approximately 0930 hours her mother was
walking west on the northern sidewalk in front of 3904 NE 4th St. She said that a vehicle had stopped
exiting the parking lot, and her mother continued walking, as she crossed in front of the vehicle to
suddenly drove forward and struck her. Elidia was struck and knocked down, the driver of the vehicle
stopped and offered Elidia a ride home which she accepted.
The police were not called at this time.
The driver took Elidia home, but she could not walk and then called Maria. Maria had the driver take
Elidia to Valley Medical Center where she was diagnosed with a broken hip.
Maria said that the driver identified himself as Nicholas Schaefer and provided his insurance and
phone number. Maria did not know what his vehicle information was. I called the phone number
provided for Nicholas and did not receive an answer.
I performed a LINX check of the phone number, and it returned to a Nicholas B Shaefer DOB:
10/15/1982 to a Lake Stevens WA address. He was clear and valid. I was not able to speak with
Nicholas about the collision.
This report is for documentation purposes only.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 3/6/2026 Renton WA
PAGE 3 OF 4
REPORT NO. EG91272 CASE# 26-1793 DATE AND TIME i 02/14/26 09:30
OF COLLISION
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