HomeMy WebLinkAbout26-1925 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG91279OLCERA
COLLISION REPORT 1591971
INTERSTATE ❑ CITY STREET FIRE I
CASE# 26-1925 2
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 03 STRUCK ❑
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E IN eDL�ISION' 03 - 11 - 2026 1212 17 =.= S 8 W❑ OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
BENSON DR S
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e S 16TH ST
0 1 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:5592147418 0 7 30
6 LAST NAME TRAN FIRST NAME RICHARD MIDDLE K 1 1 2 31
INITIAL
STREET ] 12631 SE 165TH ST CITY; RENTON ST WA ZIP; 980585547 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCK YES ND INTERLOCKVEs Na YES NOD
8 DCIENSE# STATE WA SEXI M MMDDYY' 04 - 20 - 2007 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET CLASSY 1 NATURE of INJURIES 2❑
LICENSE, CKF4869 STATE WA V JTHCK262975008931 3
10� PI ATP rt IN#
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM To
TRLR TRLR 5 1 33
12 0 Q VIN#' VIN#
FROM TO
VT VEHICLE
13 2 VEH.YEAR 2007 MAKE LEXS MODEL IS STYLE VEHICLE TO YED NO IyS46LIN diW9YMEYER GESr`] - 9 9 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO TAI TRAN 12631 SE 165TH ST RENTON WA 98058 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3
14 LIABILITY INSURANCE❑ INSURANCE CO AMERICAN FAM BX13842787 4
IN EFFECT &POLICY# 9TOP _
srnNowc ❑ ❑ 6AO095367 CHARGE FOLLOW VEHICLE TOO CLOSELY t a oorrob z 36
Yes NO CITATION#
15❑
UNIT 02 MGTOR PEDAL- ❑ PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE CIWNFR
16�
LAST NAME RAMOS FIRST NAME YOHANA MIDDLE'
INITIAL
17 F1 STREET ❑❑ 4338 S CEDAR ST APT 203 CITY TACOMA ST, yyq ZIP 984096611 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED (GNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES No INTERLOCK YES NO vEs NO
19 DRIVER'S STATE WA SEX,F I D.O.B. 1 09 01 1990 � 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 7 HELMET INJURY NATURE OF INJURIES ❑ 40
USE CLASS NECK
21 LICENSE CUA0654 TATe WA VIN# 5YFBU4EE8DP154847 41
22❑ [TILER TRAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 201$ MAKE TOYT MODEL COROLL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24❑ DAMAGE YES NO VES NO
REGISTERED OWNER INFO YOHANA RAMOS 4338 S CEDAR ST APT 203 TACOMA WA 984096611 D:7702469227 VEHICLE NO.2
SHADE DAMAGEAREA
3
LIABILITY INSURANCE INSURANCE CO NEW SOUTH 2O30770594
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ CITATION11 CHARGE t080TTOM
L'—LY YES NN"Lv=I1
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
❑
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG91279
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1925
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 INJURY NATURE OF INJURIES
POS. ' USE GLASS 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
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 03-11-26 02:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/2/2026 1:21:17 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED'; 12:13 PM TIME POLICE ARRIVED i 12:15 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF
REPORT NO. EG91279 CASE# 26-1925 O OF COLLISION TIME 03/11/26 12:12
NARRATIVE
blk/3 rear blu/2 stop blk/1 stop lane 1 nb
CC
Within the city limits of Renton/King/Wa I responded to a 3 car blocking crash at Benson Dr S at S
16th St.
When I arrived I located 3 vehicle in lane one facing/blocking northbound.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me traffic was stopping/had stopped
in front of him and although he applied the brake pedal hard he slid into unit 2 shoving her into unit 3.
He told me he thought he brake pedal may have not been working. He gave me permission to check,
and his pedal seems to be fine. When I checked his brake pedal there was a large black water bottle
on the floor. I asked if this impeded he braking ability and he told me no.
I contacted the driver of unit 2 who had just stopped for traffic in front of her when she was hit by unit
1 and shoved into unit 3. She did complain of injury and was checked on scene by Renton Fire. She
was not transported from the scene. Damages to her vehicle did not require a tow truck.
I contacted the driver of unit 3 who was stopped for traffic when the chain reaction collision took
place. He did complain of injury. He was checked and released by Renton Fire onscene. Damages
to his vehicle did not require a tow truck.
I cited unit 1 Ref RCW 46.61.145 Following too close causing a 3 vehicle injury crash via complaint.
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 3/11/2026
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG91279
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE# 26-1925
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # PLACARD
GWUR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE ( CYCLE ❑ PEDESTRIAN OWNER ❑'. YES NO
0 7 29
I NNITIAITIAL E
LAST NAME NAGRA FIRST NAME MANJINDER I ' S
STREET 01 30
NEW ADnRFj 17320 126TH AVENUE CT E CITY PUYALLUP ST WA II
ZIP 983746822
6 [2 PRESENT MEDICALTANSPORTED. 1 1 2 31
CDL A- REQUIRED {GNiTION
INTERLOCK Yes NO INTERLOCK YES NO vEs N..
L
DRIVER'S WA SEX M MDDY 10
7
LICENSE; MMDDvv - 18 - 1985
HELMET INJURY NATURE OF INJURIES
ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS `7 NECK
LICENSE I CGZ9426 TAT WA VIN 7SAYGAEEOPF766964 32
PLATE#
9 Fq] STATE TRAILER TRAILER L
PLATE# PLATE# STATE
0
10 ❑ TRLR TRLR
VIN.# VIN#.
11 0 0 VEIL YEAR2023 MAKE TESL MODELMODEL Y STYLE VEHICLE TOWE E T ABLIN TOWED BY GovT vEHICI F FROM To
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFOGURBACHAN MAAN 17320126TH AVENUE CT E PUYALLUPWA98374 SHADE IN DAMAGED AREA 9 9 33
12 z 3 4
FROM TO
INSURANCE CO
LIABILITY INSURANCE ALLSTATE 864 264 021
IN EFFECT &POLICY# I 1:0i f.-- m 34
13 ❑ vewc�e YES NO[jj CITATION# CHARGE 1080TTOM
ecauv
s-rnNoiNc �
MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET �' CITY ST' ZIP
NEW ADDRESS
CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES NO INTERLOCK YES1:1 NO .YES NO ❑
17 37
LICENSE#RIVERS —F SEX MD.r30.6 — l
18 ❑ ❑
HELMET 'INJURY NATURE OF INJURIES 38
ON DUTY STATUS' AIRBAG RESTR. EJECT USE CLASS.
19 ❑ ❑ 39
LICENSE TAT AN#
PLATE#
20 TRAILER+ TRAILER 40
PLATE#. STATE PLATE# - STATE ❑
21 ❑ TRLR TRLR 41
VIN# VIN#Y
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY#
..
t.
E 44
24 YES❑ NO CITATION# CHARGE K-99
STF_ G 3
3 G
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-11-26 02:46 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
BADGE 1 APPROVED
1
�ORIWA0171300 A 2122 PAGE 2517 OF
ORID# #
3000-345-013(R 11t18)
REPORT NO. EG91279 CASE# 26-1925 DATE AND TIME 03/11/26 12:12
OF COLLISION
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