HomeMy WebLinkAbout26-1389 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG91274oc� RA
COLLISION REPORT 1591971
ASE# 26-1389 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`GENC'Y. 4100 3
COUNTY RD ❑ INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 02 SOBJECT 7RUCK 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 - 18 - 2026 1500 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
MAPLE VALLEY HWY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�. FEET H S 8 W e 131ST AVE SE
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4255269510 0 7 30
6 LAST NAME SIMON FIRST NAME IVY MIDDLE H 1 1 2 31
INITIAL
STREET ❑ 6505 DENNY PEAK DR SE CITY SNOQUALMIE ST WA ZIP 980658995 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCK YEs No INTERLOCKYES NO YES NO
8� LICIENS# STATE WA SEX F MMoCSYY' O6 - 25 - 2006 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT, 1 HELMET INJURY 6 —NATURE of INJURIES 2
USE CLASS WRIST
LICENSE CDV3938 STATE WA VN# 3VWJ07AT3FM638266 3
10[9� as ATP rt'
11[-� TRAILER STATE TRAILER ,STATE
11 4 0 PLATE# PLATE# FROM TO
rRLR TRLR 7 3 33
12 0 0 VIN# VIN#
( FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT VEHICLE 9 9 34
13 2 2015 YOLK BEETLE DAMAGE ves ✓ No �MEYER Yes❑ No
REGISTERED OWNER INFO JENNIFER SIMON 6505 DENNY PEAK DR SE SNOQUALMIE WA 98065 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE[ NSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 4TOP
vEnic�E 5 36
LEGALLY YES❑NO❑I CITATION# CHARGE 7 o BOTTOM
15❑ STANDING I 7 e
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ nWNFR YEs,/ No D:2535080641
16�
LAST NAME COATS FIRST NAME DANIEL MIDDLE' R
INITIAL
STREET ❑ 37
17 '❑ 25306 182ND AVE SE CITY COVINGTON ST, WA ZIP 980424804
NEW ADDRESS
18❑ CDL IGNITION REQUIRED �GNITIGN PRESENT MEDIGALTRANSPQRTED. 38
INTERLOCKvEs ND jNTERLOCK YES No Yes NU'
19 DRIVER'S STATE WA SEX,M I D.Q.B. 11 09 1988 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENS C46708S rarE WA vIN# 1C6JJTBG1LL134135 41
22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2020 MAKE JEEP MODEL GLADIAT STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO DANIELCOATS25306182NDAVESE COVINGTON WA 980424804 D:2535080641 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO GARRISON 01 197 58 48R
IN EFFECT &POLICY# t 9TOP
VEHICLE LEGALLY ,.I—I CITATION# CHARGE tO BOTTOM
25 YES N`LJ
a 7 a
--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. EG91274
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1389
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 02-18-26 04:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/2/2026 1:18:40 PM
BADGE OR ID# Y517 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 3:01 PM TIME POLICE ARRIVED 3:06 PM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG91274 CASE# 26-1389 O COLLI COLLISION TIME
OF 02/18/26 15:00
COLLI
NARRATIVE
red/2 stopped lane 1 slv/2 rear
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking injury crash near the
13100 block of Maple Valley Hwy.
I contacted the driver of unit 2 who told me he was stopped for heavy traffic southbound lane 1 when
he was hit from behind by unit 1. He did complain of a sore neck. He was checked and released on
scene by Renton Fire. Damages did not require a tow truck.
I contacted the driver of unit 1 holding her arm and I could see redness, some blood and swelling.
Unit 1 told me she saw traffic in front of her was slowing and stopping. She told me she applied the
brakes but her foot slipped of the brake pedal and she contacted the back of unit 2. Injury to her wrist
is probably from the airbag deployment. Damages required a tow truck. Unit 1 was transported by
Renton Fire to VMC-ED for further checks/treatment.
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 2/18/2026
PAGE 3 OF 4
REPORT NO. EG91274 CASE# 26-1389 DATE AND TIME i 02/18/26 15:00
OF COLLISION
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