HomeMy WebLinkAbout26-3857 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 26-3857 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 2 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# ❑
COLLISION' 05 - 19 - 2026 1547 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e✓ 405
4a❑ 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:4258661158 0 7 30
6� LAST NAME ELLIS FIRSTNAME NIBARI MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 11437 69TH PL S CITY SEATTLE ST WA ZIP 981783002 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CVT6156 sTAT� WA urN# 1 YVHP80C855M54945
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 ZOOS MAID 6 SE DAMAGE YES NO YES[:] NO
REGISTERED OWNER INFO ODILIA ELLIS 1143169TH PL S SEATTLE WA 98178 D:2066438298 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE INSURANCE CO NEW SOUTH INSURANCE CO2030969217 3 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLY HICI.E 5 36
YES�No D CITATION# 6A0254439 CHARGE FOLLOW VEHICLE TOO CLOSELY 10 eorrom
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD M PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4252806292
16 a ET
LAST NAME BLAU FIRST NAME CHRISTOPHER MIDDLE I K
INITIAL
17❑ STREET ❑', 12121 ADMIRALTY WAYAPT S300 CITY EVERETT ST WA ZIP 982047520 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCK YES�NOR INTERLOCK YEs I I NOF YES t l No❑
19[ LICENSE# STATE WA SEX M M D.C.B. 01 22 _ 1969 0 39
HELMET I INJURY NATURE OF INJURIES 40
20� ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE CLASS 7 NECK PAIN
21❑ LICENSE I C78866M TATe WA VIN1t 3N6CMOKN7HK716261
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE NISS MODEL NV200 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO AQUARIUM CONCEPTS INC 623 NWRICHMOND BEACHRD SHORELINE WA 98177 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 584 2707-F16-47IN 1 GD
vewcLe CITATION# CHARGE
LEGALLY YES Nu
25❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EHO5319
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3857
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
PM 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.
C.ARNOLD 05-19-26 04:22 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 5/22/2026 11:19:05 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 3:50 PM TIME POLICE ARRIVED',3:58 PM
PART I PAGE IT]OF 4�
REPORT NO. EH05319 CASE# 26-3857 OF COLLISION
05/19/26 15:47
OF CbLLI510N
NARRATIVE
CC 26-3857
On 5/19/2026 at 1550 hours I was dispatched to a motor vehicle collision at the 400 block of Logan
Ave N in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was facing South on Logan Ave N just prior to N 4th St at around the 400 block
in the #1 lane, stopping for traffic.
Driver 1 stated that he was behind Unit 2 in the #1 lane of Southbound Logan Ave N.
Collision
Driver 2 stated that while stopped, Unit 1 approached from behind and the front bumper of Unit 1
collided with the rear bumper of Unit 2.
Driver 1 stated that he was looking around and did not see that Unit 2 had stopped. Driver 1 stated
that the front bumper of Unit 1 collided with the rear bumper of Unit 2.
Injuries
Driver 2 complained of neck pain.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a motor
vehicle shall not follow another vehicle more closely than is reasonable and prudent, having due
regard for the speed of such vehicles and the traffic upon and the condition of the highway.
Driver 1 was cited reference RCW 46.61.145.
1 certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 16:17 on 5/19/2026 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EH05319 CASE# ' 26-3857 DATE AND TIME 05/19/26 15:47
OF COLLISION
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PAGE 4 OF 4