HomeMy WebLinkAbout26-2745 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-2745 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cawsloN 04 - 09 - 2026 0743 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LK WA BL N BLOCK NO. e✓ 1200
4a 9❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES
NO ,/ D:4257666193 0 9 30
6� LAST NAME STILLWELL FIRSTNAME JONATHAN MIDDLE V 1 2 31
INITIAL
STREET ❑ 35805 4TH PL SW CITY FEDERAL WAY WA
NEW ADDRESS ST ZIP 980237344 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 2 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 7� I P1 ATNES# 62407D sTAT WAV N# 1 LV4052RCG400351
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 2 2016 DEER TYPEA DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO CITYOFRENTON3555NE2ND ST RENTON WA 98056 D:4254306700 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME, 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LEGALLY STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2532788349
LAST NAME CARTY FIRST NAME ELAINE MIDDLE M
INITIAL
17❑ STREET ❑', 24217 93RD CT S CITY KENT ST WA ZIP 980305041 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 DRIVER'S STATE WA ]SEX IF D.C.B. 03 _ 30 _ 1971 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 1 CLZ0063 TATe WA YIN. 4T1(B118K1RU130645
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2024 MAKE TOYT MODEL CAMRY STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MYRNA CREECY 2421793RD CT S KENT WA 98030 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM L26 1274-E12-47HIN IU
STOP
vE""LE CITATION# CHARGE o BOTTOMLEGALLYYES N�25❑ J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99599
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2745
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'
In 1 rt stopped by flagger grn/1 blk/2
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash near the 1200 block of Lk
Wa BI N.
I contacted both vehicles near the boat launch area inside Coulon Park.
Unit 2 told me she was directed by a flagger inside a construction zone to stop, which she did when
she was hit front behind by unit 1. She did not complain of injury and damages did not require a tow
truck.
I contacted the driver/operator of unit 1. Unit 1 was directly behind unit 2 and was unable to stop in
time when the flagger directed unit 1 to stop. He said he wasnt going but walking pace when he
contacted the back of unit 2. He did not complain of injury and there was no sign of damages.
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 4/9/2026
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-15-26 11:36 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/23/2026 1:49:32 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED', 7:43 AM TIME POLICE ARRIVED';7:55 AM
PART I PAGE IT]OF 3�
REPORT NO. EG99599 CASE# 26-2745 DATE AND TIME 04/09/26 07:43
OF COLLISION
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