HomeMy WebLinkAbout26-3755 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 26-3755 2 676
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 02 STRUCK' TREE OR STUMP
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 05 - 1-- 2026 1113 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 180TH ST BLOCK NO. e✓ 8000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FMILES N EET e S ❑ E e 88TH AVE S
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2534279645 30
6� LAST NAME ANNI FIRSTNAME ZALTON MIDDLE T 1 1 1 31
INITIAL
STREET ❑, 5951 N 11TH ST CITY FORT LEWIS ST WA ZIP, 98433 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
❑ DRIVER'S' STATE JA SEX'M MELO B 12 — 18 — 2003 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELM
USEET I IINLJA
URY 1 [!!RE OF INJURIES 2❑
3
LICENSE CSV8258 STATE WA VIN# 5YJ3E1EA6JF053908
10❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. RLR 1 7 33
12❑ VIN#j VIN#'
2018 TESL MODEL SD I FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13� DAMAGE YES NO 1/ YES[:] NO
REGISTERED OWNER INFO SIMON NAMDRIK 12402 ADMIRALTY WAY EVERETT WA 98204 D:4252215160 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO PROGRESSIVE 86966215 3 4
IN EFFECT &POLICY# 9TOP
VEIiICLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY ✓ DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4254306400
16❑
LAST NAME CITY OF RENTON FIRST NAME MIDDLE
INITIAL
17❑ NEW STREETREs7 1055 S GRADY WAY CITY RENTON ST WA ZIP 98373 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LLIICENS RIVERIS# STATE SEX U MMDDYY 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TATE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1GQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH03452
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3755
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'
26-3755
On 05/15/2026 at approximately 1113 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred in approximately the 8000 block of S 180th ST, which is located in the City of
Renton, County of King, and the State of Washington. I was in my fully marked police vehicle,
wearing my patrol uniform and body worn vehicle.
I arrived on scene and observed Unit#1, a 2018 Tesla Model C with license plates CSV8258 issued
out of Washington State, had struck a tree on the north side of the roadway.
I contacted the driver of Unit#1, Zalton T. Anni (DOB 12/18/203), who told me the following: Anni
made a right turn out of the Ikea parking lot on westbound S 180th ST and attempted to put the
vehicle into autopilot. Anni lost control of the vehicle which veered off of the roadway into the tree.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by Anni. The roadway was wet, and it was currently raining. The rear tires of the
vehicle were worn bald. Unit#1 had significant damage to the front bumper which was pushed into
the frunk.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Anni.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1049 hours on 05/16/2026 at Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 05-16-26 11:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 5/16/2026 4:31:36 PM
BADGE OR ID# 12575 OR]# ! WA0171300 TIME POLICE DISPATCHED 11:15 AM TIME POLICE ARRIVED 11:23 AM
PART I PAGE IT]OF 3�
REPORT NO. EH03452 CASE# ' 26-3755 DATE AND TIME 05/15/26 11:13
OF COLLISION
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