HomeMy WebLinkAbout26-3201 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-3201 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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 N E IN CITY#
COLLISION' 04 - 1-- 2026 1845 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e✓ 14000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 �,❑ FEET e S ❑ VV e 140TH WAY SE
❑
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2067692266 0 11
30
6� LAST NAME ALLEN FIRSTNAME SIENNA MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 16310 128TH PL SE CITY RENTON ST WA Zlp' 980585506 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 1❑ P1 ATE 14 CUR5269 STATE WA u N# KL47LCEP6SB238157
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# IR.. ro
TRLR. TRLR. 5 3 33
12 4 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 3 34
13 2 2025 BUIC ENVIST DAMAGE vEs 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO MARCELLA ALLEN 11310128TH PL SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 LIABILITY INSURANCE FARMERS CASUALTY INS 4201938680
IN EFFECT &POLICY# � 9TOP
VE"'CLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4256236761
16 a
LAST NAME MAIER FIRST NAME JARED MIDDLE R
INITIAL
17❑ STREET ❑', 3917 SW KENYON ST CITY SEATTLE ST WA ZIP 981362330 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVERS
# STATE WA SEX M MMor w 12 _ 30 _ 1996 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE CGG8493 TATe 41
WA VIN# 4S3BP676056355224
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2005 MAKE SUBA MODEL LEGACY STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO JARED MAIER 12309200TH AVE BE ISSAQUAH WA 98027 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU PORGY#E CO STATEFARM 5384730-E12-47AIN STOP 5
VEHICLE ❑ C[:] CITATION# CHARGE io BOTTOM
LEGALLY YES N`LJ
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99690
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3201
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'
Unit 1 was stopped at a red light on northbound 140th WAY SE at Maple Valley HWY, in the far right
turn lane, intending to turn right onto eastbound Maple Valley Hwy. Unit 2 was traveling eastbound
on Maple Valley HWY approaching 140th WAY SE with a green light and the right of way.
Unit 1 failed to yield the right of way to Unit 2, and pulled out onto Maple Valley HWY into the path of
Unit 2. This was the proximate cause of the collision. Unit 2 was unable to stop or avoid a collision,
and the front end of Unit 2 impacted the rear of Unit 1. Video of this collision was provided by Driver
2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-25-26 03:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 5/4/2026 9:28:01 AM
BADGE OR ID# 10008 OR]#' ' WA0171300 TIME POLICE DISPATCHED 6:47 PM TIME POLICE ARRIVED',6:58 PM
PART I PAGE IT]OF 3�
REPORT NO. EG99690 CASE# ' 26-3201 DATE AND TIME 04/24/26 18:45
OF COLLISION
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