HomeMy WebLinkAbout26-3637 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-3637 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 5 1 28
TOTAL#OF OBJECT
TRIBAL UNITS 03 STRUCK' FENCE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 05 - 11 - 2026 1645 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 5325
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4258665557 0 11
30
6❑ LAST NAME KHURRAM FIRSTNAME SHAHBAZ MIDDLE 1 2 31
INITIAL
STREET ❑, 961 10TH PL NE UNIT 206 CITY ISSAQUAH ST WA ZIP, 98029 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO,/ YES ,/ NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 12 1— 18 — 1988 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 I [NATURE OF
H U EET 2 1 INJURY
CLASS 6 KNEE PAIN JURIES z❑
3
LICENSE CVS9067 STATE WA VIN# 2HGES25762H581991
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 7 34
13 4 2002 HOND CIVIC SD DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO ROOT INSURANCE 9MC3XV 4
IN EFFECT &POLICY# 9TOP
VIC CHARGE 1 36
LECALLEHLEv res�NO D CITATION# 1 o BOTTOM
15❑ STAIN,DIING 8 7 6
UNIT 02 vEHIMOTOCLE CYCLE ❑ PEDESTRIAN ❑ oWNFR PEDAL RTY ❑ DYES NO OLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME UNKNOWN MIDDLE
INITIAL
STREET CITY RENTON ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LLIICENS # STATE SEX U MMDDYY —�_ ❑ 39
20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 H U EET 9 LASS O NATURE OF INJURIES 40
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE IbIITS MODEL UNKNOW STYLE SD VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO (NEWJ VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SLAKE BOWIE 12105 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EHO5118
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3637
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) UNKNOWN KIRK
(LAST FIRST,
ADDRESS&PHONE#
UNKNOWN RENTON WA 98056 2067950145 SEX M MMDDYyry -�-
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 05-11-2026 at 1657 hours I was dispatched to 5325 NE Sunset Blvd, in the City of Renton,
County of King, State of Washington, for a reported one vehicle collision into a fence.
Upon arrival, I saw unit 1's vehicle off the road and through apart of the fence of 5325 NE Sunset
Blvd. The driver had knee/leg pain and was being evaluated by the Renton Fire Department. He was
unable to give his side of the story as he was in to much pain and needed to be transported.
I spoke to the owner of the residence, Mirley, and she was able to show me video of the incident. Her
video shows Unit 1 driving eastbound and a silver Mitsubishi sedan driving westbound came across
the center line towards Unit 1. Unit 1 swerved out of the way to prevent a head on collision and went
off the road ultimately crashing into the fence. The Mitsubishi continued to drive westbound and never
came back to the scene. 1 sent Mirley an Axon evidence link to upload the videos to and she agreed
to upload them. See video for further information.
A witness, Kirk, was in his truck driving eastbound behind Unit 1 when the other vehicle came across
the center line and caused Unit 1 to swerve.
I provided all parties involved with my business card which contained the case number for their
records.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electrically signed by Officer B. Bowie / 12105 on 05-11-2026 at 1757 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SLAKE BOWIE 05-11-26 06:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
PHILIP DAVIS 12018 1 5/22/2026 10:25:27 AM
BADGE OR ID# 12105 ORI# WA0171300 TIME POLICE DISPATCHED! 4:51 PM TIME POLICE ARRIVED',4:53 PM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. EH051 1 8
r`) POLICE TRAFFIC 1 27
COLLISION REPORT CASE# 26-3637
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: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs� NO
D:4259193933
MIDDLE.. 29
LAST NAME BASTO FIRST NAME MIRLEY INITIAL M
STREET 30
❑ NEW AnnRFSP 5325 NE SUNSET BLVD CITY RENTON ST WA ZIP 98056
6
CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YEs No zERLOCK YES❑N0� vES N
L
DRIVER'S STATE SEX F M�DDYBYv 08 - 01 - 1998
LICENSE
7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
USE GLASS
8 ❑ ' 1 32
LICENSE+ rar VIN.#
PLATE#
9F-I TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIC P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO. m 33
12 SHADE IN DAMAGED AREA
FROM TO
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# tGQ
EHILLE 34
13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE
STANDING } 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36
STREET
16 NEW AnntxFs.� CITY'. ST ZIP
CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ vIN 39
LICENSE #
PLATE# rnr
20 ❑ TRAILER' TRAILER ❑ 40
PLATE# STATE PLATE# STATE
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 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
C=DLv
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.
BLAKE BOWIE 05-11-26 06:14 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OBADGE R ID# 12105 O#I',WA0171300 APPROVED
PDAVISBY 5%2E2/2026 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. EH05118 CASE# ' 26-3637 DATE AND TIME 05/11/26 16:45
OF COLLISION
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