HomeMy WebLinkAbout26-3622 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 26-3622 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK' TREE OR STUMP
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 0330 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
PERIMETER RD W BLOCK MILEPOST
e✓ 900
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 N:2068530423 30
6� LAST NAME GORDON FIRSTNAME NATHANIE! MIDDLE R 1 2 31
INITIAL
STREET ❑ 11420 87TH AVE S APT 1 CITY SEATTLE ST WA Zjp, 98178 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR 1 EJECT 1 H U EET 2 CLASS 7 I [NATURE OF INJURIES
CUT ON HEAD/KNEE PAIN z❑
3
10❑ P1 ATE 14 BSM6731 STATE WA VIN# 2GNAXSEV1L6160519
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR. TRLR. 5 1 33
12❑ VIN#j VIN#
FROM
34
13 4 VEH.YEAR2020 MAKE CHEV MODEL EQU/NO STYLE VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYERS vOs❑ENo /
❑ DAMAGE IILLJJII (�ciV6
REGISTERED OWNER INFO NATHANIEL CORDON 11,12087THAVES APT 1 SEATTLE WA 98178 M2068530423 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE Z INSURANCE CO FARMERS UNKNOWN AT TIME OF REPORT
IN EFFECT &POLICY#
'C ve ❑ 36
LECALLv res❑NO❑ CITATION# CHARGE BOTTOM
15❑ STANDING
�UITN 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLEITIAL
IN
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH06635
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3622
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'
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.
JAKE GALL 05-11-26 04:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
NICOLAS SANGDER 11350 1 512812026 1:41:38 AM
BADGE OR ID# 12617 OR]# ': WA0171300 TIME POLICE DISPATCHED 3:31 AM TIME POLICE ARRIVED 3:33 AM
PART I PAGE IT]OF 4�
DATE AND
REPORT NO. EH06635 CASE# 26-3622 OFCOLISION 05/11/2603:30
OF COLLISION
NARRATIVE
*This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. *
The following occurred within the City of Renton, King County WA and was recorded on my body
worn camera.
On 05/11/2026 at around 0330 hours, Renton Officers were dispatched to a single vehicle collision
located near the 600 block of West Perimeter Road.
I arrived on scene and observed that vehicle 1 was on its roof, facing South, on the grassy
embankment on the West side of West Perimeter Road. I spoke with driver 1, the sole occupant of
the vehicle. Driver 1 had a cut on his forehead and was bleeding. He also complained of knee pain.
Renton Fire was dispatched to the scene for treatment.
Driver 1 stated that he was traveling North on Rainier Ave N in lane one of two. He mentioned that he
fell asleep while driving. Rainier Ave N slightly curves to the left while traveling North near the 600
block. Driver 1 failed to navigate the slight turn in the road because he was asleep, causing the
collision. Vehicle 1 left Rainier Ave N, launched into the trees/greenbelt that separates Ranier Ave N
with West Perimeter RD, and landed on its roof facing southbound.
Driver 1 provided all his information. His Farmers insurance car was not located the vehicle during
the time of call. His policy number is unknown at this time.
I did not detect any signs of intoxication. 1 did not locate any tire marks on Ranier Ave N which would
indicate that Driver 1 applied the brakes before leaving the roadway. Driver 1 was transported to
Valley Medical Center as a precaution. It did not appear the Driver 1 was wearing his seatbelt per
Renton Fire.
Gene Meyers towing was called to the scene to take possession of the vehicle.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Gall/12617
05/11/2026 at 0430 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. EH06635 CASE# 26-3622 DATE AND TIME 05/11/26 03:30
OF COLLISION
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PAGE 4 OF 4