HomeMy WebLinkAbout26-2535 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG91295 170
27
COLLISION REP FIT 1591971
CASE 26-2535 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 04 - 01 - 2026 1417 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DUVALL AVE NE BLOCK NO. e✓ 450
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4259192297 0 11
30
6� LAST NAME ROS FIRSTNAME SREYMOM MIDDLE N 1 2 31
INITIAL
STREET ❑, 3921 NE 11TH PL CITY RENTON ST WA ZIP 980563538 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJU:SY 0 NATURE OF INJURIES z❑
3
10 9❑ PI ATE 14 AWR3227 STATE WA VIN# 1 HGCR2F86FA091873
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 201$ HOND ACCOR DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO SREYMOM ROS 3921 NE 11TH PL RENTON WA 980563538 D:4259192297 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 402 544 OC 28478
IN EFFECT &POLICY# 9TOP
❑ LEGALLY CHARGE 1 5 36
15 2 YEs No clTAnoN# IMPROPER LANE USAGE o aorrom
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES V NO D:2067954585
16 a
LAST NAME NELSON FIRST NAME KOLEDEN MIDDLE I T
INITIAL
17❑ STREET ❑', 23501 112TH AVE SE APT B101 CITY KENT ST WA ZIP 980313422 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l No❑
19[ LDI IVE STATE WA SEX DDY
M M D.C.B.
07 1 25]_ 2003 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE D94557D TATe I WA VIN1t 1FT8W3BT5NEE46603
❑ 41
PLATE# ❑
42
22❑ TRAILER 62O71AA STATE WA TRAILER STATE
PLATE# PLATE#
43
23❑ VIN# 4ZEDT1220H1137972 IN
VEH YEAR 2022 MAKE FORD MODEL F350 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KOLEDEN NELSON 23501112TH AVE SEAPT B101 KENTWA980313422 D:2067954585 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 937688929IN I STOP 5
'EwCLE ❑ Nu
J
,J� CITATION# CHARGE
LEGAL
25 to BOTTOM
LY YES s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG91295
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2535
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. 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 04-02-26 07:27 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 4/2/2026 2:04:34 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 2:18 Pry TIME POLICE ARRIVED',2:20 PM
PART I PAGE IT]OF 5�
REPORT NO. EG91295 CASE# 26-2535 OF COLLISION
04/01/26 14:17
OF CbLLI510N
NARRATIVE
2/wht-trlr lane 2 1 blk/lane one into lane 2 unit 2 rotates now facing nb continues and hits unit 3
blue lane 2
CC
Within the city limits of Renton/King/Wa I responded to a 3 vehicle crash at near the 450 block of
Duvall Ave NE.
I contacted the driver of unit 2 who told me he was southbound lane 2 on Duvall Ave NE when unit 1
in lane one going the same direction made a sudden lane change across the front of his truck and
trailer striking his front passenger bumper and fender. He said unit 1 rotated around the front of his
truck. Unit 1 told me he tried to brake and avoid unit 1 but she was so close that contact was
inevitable. Unit 1 did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by her matching picture WADL. She told me she signaled and
changed lanes but in the same space/area of unit 2. She did not provide any additional information
and at this point was being checked by Renton Fire. Damages did require a tow truck.
I contacted the driver of unit 3 who told me he was behind unit 2 and although he applied his brakes
to avoid unit 1-unit 2 collision he told me that unit 1 after spinning out post contact with unit 2
continued north and drove into the driver side of his truck. He did complain of injury and was checked
by Renton Fire. Damages did not require a tow truck.
I cited unit 1 via complaint Ref RCW 46.61.140 improper lane use/improper lane change causing a 3
vehicle injury crash.
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 4/2/2026
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EG91 2955
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 26-2535
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GWVR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J CYCLE _) PEDESTRIAN � OWNER � YES� NO
D:2064452774
0 1 Zg
LAST NAME MICUS FIRST NAME : JACKSON MIDDLE'.. M
INITIAL
STREET 30
NEW AnDRFrtP 14004 144TH AVE SE CITY RENTON ST WA ZIP 980595530
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs No NTERLOCK YES�NO� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 10 - 31 - 2008
7
HELMET :INJURY' NATURE OF INJURIES
ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 7 NECK
8 ❑ 32
LICENSE BYL4308 TAr WA VIN# 1GKEK13K1SJ757249
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR199 Jr MAKE GMC I MODEL YUKON I STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1Ci P FROM TO
DAMAGE YES NO YES NO
33
REGISTERED OWNER INFORICHARD MICUS 14004144TH AVE SE RENTON WA 98059 1 5
12 SHADE IN DAMAGED AREA
7 j 4 FROM TO
LIABILITY INSURANCE INSURANCE CO COUNTRY P46A4228927 q"i"Olx
IN EFFECT &POLICY# 1
VEHICLE 34
CITATION# CHARGE 10 BOTTUM
13 LEG LEY YES NO
STANDING❑ dRD PROPERTY Y
❑ 35GNHROE
VEHICLE CYCLE OWNER O14 UNIT�
j PHONE
15 LAST NAME FIRST NAME INITIAL
36
MIDDLE ❑
STREET"[-]
16 NEW nnR CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY -� II
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38
USE (CLASS
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-02-26 07:27 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OI BADGE 2517 O#I WA0171300 JACOBS 4/2/2026 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. EG91295 CASE# ' 26-2535 DATE AND TIME 04/01/26 14:17
OF COLLISION
t'
a.
k
�v �y
o-
� u
N,
i
t x. PAGE 5 OF 5