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
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