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HomeMy WebLinkAbout26-3500 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 26-3500 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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# cawsloN 05 - 1-- 2026 1610 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e✓ p ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e S 3RD ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2067796684 0 11 30 6❑ LAST NAME ASGEDOM FIRSTNAME MELAK MIDDLE M 1 1 2 31 INITIAL STREET ❑ 4224 184TH ST SW CITY LYNNWOOD ST WA 2jp, 98037 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 01 1- 01 - 1978 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ Pi aT�S� C168475 sTArI WAVIN# 4V4NC9EH8FN920250 TRAILER PD34503 STATE IN TRAILER STATE 11 0 0 PLATE# PLATE# ROM ro rRLR. TRLR 5 7 33 12 0 0 VIN#' VIN#' FROM TO VEH.YEAR 2015 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 4 VOLV VNL64T DS DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 00775451.1 3 4 IN EFFECT &POLICY# 9TOP vECEHA"LE 5 36 LIIv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063056428 16 a LAST NAME MCANALLOY FIRST NAME ZETH MIDDLE Ij INITIAL 17 STREET NEW ADDRESS❑' 22521 3OTH AVE S APT 1 CITY LYNNWOOD ST WA ZIP 98198 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 D IVERI # ❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ 41 21❑ PLA E# CGY3479 TArE WA VIN# 3N1ABSCV5LY302658 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2020 MAKE NIS5 MODEL SENTRA STYLE SO VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO DEVIN MCANALLOY 2252130TH AVE S APT I LYNNWOOD WA 98198 D:2068787997 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POLICY#E CO STATEFARMIN 9TOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MICAH BATTLE 12049 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EH06634 COLLISION REPORT III III III III III 111 1591972 CASE# 26-3500 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) SIMON JOSEPH (LAST FIRST, ADDRESS&PHONE# 4255728474 SEX' U MMDDYYYY -❑ ---------------------------- PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) MCEVILLY CHASE ADDRESS&PHONE# D O B 2066880602 SEX: U MMDDVYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST FIRST,MIDDLE INITIAL) BOSEWICHT SABRA ADDRESS&PHONE# 7437 S 129TH ST SEATTLE WA 98178 7143604673 SEX M M _ 28 _ 1963 MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS ----� NARRATIVE' 26-3500 On 5/5/26 at 1805 hours, I was dispatched to an accident at S 3rd St and Rainier Ave S in the City of Renton, County of King, Washington. Unit 1 was identified as Melak M. Asgedom (1/1/78, verified by WADI-), who was driving WA- C 16847S. Unit 2 was identified as Zeth J. McAnolloy (6/14/05, verified by WADI-), who was driving WA- CGY3479. Witnesses: Joseph Simon, Chase McEvilly, and Sabra Bosewicht. Unit 1 stated he was driving north on Rainier Ave S taking a left turn (westbound) onto SW Sunset Blvd/S 3rd ST. He stated he had a green light while entering the intersection when Unit 2 pulled in front of him causing a front-end collision. Unit 2 stated he was driving south on Rainier Ave S passing through the S 3rd St intersection to continue southbound. He stated he had a green light when Unit 1 pulled in front of him causing a front -end collision. Witness Simon, and McEvilly started Unit 1 entered the intersection under a red light. Bosewicht stated that Unit 1 entered the intersection under a yellow light. I observed that the brush guard on Unit 1 was torn off. I also observed moderate front end damage to Unit 2's front and driver side front quarter panel. No reported or observed injuries. Unit 1 was cited with failure to obey traffic signals. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAH BATTLE 05-05-26 08:04 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE NICOLAS SANGDER 11350 1 512812026 1:38:18 AM BADGE OR ID# 12049 ORI# WA0171300 TIME POLICE DISPATCHED 4:11 PM TIME POLICE ARRIVED 4:15 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EH06634 r`I POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 26-3500 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT# 1 USDOr ICC# I VEHICLE TYPE 1 6 1 CARGO BODY 2 TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ AME N IF NO NUMBER SOURCE 3 AXLES 03 PLACARD + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnDRFrtP. CITY ST ZIP 6 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No INTERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYSYY' 2 7 F-I ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 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 vEHII' P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 � SHADE IN DAMAGED AREA 7 j 4 FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# t 9 101? VEHICLE o BarroM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING �} MOTOR 8 7 6 14 ❑ UNIT Tr Vd 1 RE O CYDDAL OWNERRTY YES D-AMAGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN ❑15 LAST NAME FIRST NAME NIDDL 36 STREET 16 NFln+Aon "F—] CITY ST I ZIP CDL IGNITION REdUiRED 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 ICLASS 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 TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO El 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 a 71 LIABILITY INSURANCE INSURANCE CO ' IN EFFECT � &POLICY# i 970P _ 4 E:l A44 24 ....... YES❑ NO❑ CITATION# CHARGE iq 60TiOM .Glly 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. M1CAH BATTLE 05-05-26 08:04 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OI BADGE 12049 O#I WA0171300 SANGDER 5/28/202s PAGE OF F 3000-345-013 IR 11t18) REPORT NO. EH06634 CASE# ' 26-3500 DATE AND TIME 05/05/26 16:10 OF COLLISION i4 i 44 r�'eN yY�J � 1 s 1 2 try �s , Y x t tilt r' 1t a~ v.� ate; a } +. jpp 24 �v Y.4} { .qV , yyS 5 l 3 PAGE 4 OF 4