HomeMy WebLinkAbout26-4869 TFFiNouCERA II I III 1 III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SASE 26-4869 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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# ❑
COLLISION' 06 - 1-- 2026 2220 17 ❑-❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 168TH BLOCK NO. e✓ 11000
4a❑ MILEPOST
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 D:4259026578 1 4 30
6� LAST NAME ALVAREZ FIRSTNAME ARIANA MIDDLE S 1 1 2 31
INITIAL
STREET ❑✓ 17112 118TH LANE CITY RENTON ST WA 2jp, 980561930 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CUU9329 sTArI WAurN# 1FMCU9H93DUD57966
10❑ PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 3 33
12 0 0 VIN#' VIN#
9�34
❑ OM TO
VEH.YEAR ZO13 MAKE FORD MODEL ESCAPE STYLE UT VEHICLE TOWED TO BLIN TOWED BY COS[VEHICLE
13 4 DAMAGE YES YES[:] NO
REGISTERED OWNER INFO KELVIN PALADINES CARRENO 1115 N 30TH ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO PROGRESS INS,868696724 3 4
IN EFFECT &POLICY# STOP
15
vE�EHA"LE 5 36
LLLv YEs�No M CITATION# 6A0112365 CHARGE INATTENTIVE DRIVING )o eorroM
❑ STANDING 8 7 6
UNIT MOTOR PEDAL ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
VEHICLE CYCLE: : OWNER YES�/ NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY SEATTLE ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l No❑
19 LLIICENS RIVER# STATE SEX U MMDDYY 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
LICENSE I ❑21❑ PLA E# D816046 TAre 41
WA YIN# 1N66FOKY7HN802566 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2017 MAKE NISS MODEL NV STYLE CG VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ZIP RELIABLE HEATING AND COOL 309 S CLOVERDALE ST STE D43 SEATTLEWA98108 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 STOP
VEHICLE ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES[:] N
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
YUSUF JIBRIL 12490 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH16970
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4869
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
On 06/21/2026, at approximately 2222 hours, I was dispatched to a collision in the 11100 block of SE
168th Street in the City of Renton, King County, Washington.
Upon arrival, I observed that both vehicles had sustained significant damage. Unit 1 had extensive
front-end damage, and its airbags had deployed. Unit 2 was unoccupied and legally parked parallel to
the curb on the south side of the 11100 block of SE 168th Street.
The driver of Unit 1 was outside the vehicle and did not appear to have any visible injuries. Due to the
airbag deployment, Renton Fire/Medic personnel responded to the scene and conducted a medical
evaluation of the driver.
The driver of Unit 1 stated that she had been traveling eastbound on SE 168th Street. She explained
that she was using navigation to get home, believed she could make a turn, veered off the roadway,
and subsequently collided with Unit 2, which was parked on the street.
Based on the driver's statement and the physical evidence observed at the scene, the driver of Unit 1
was issued a citation for inattentive driving.
Unit 1 was impounded and transported to Gene Meyer's towing lot. The owner of Unit 1 was provided
with an exchange of information form..
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
YUSUF XBR/L 06-21-26 11:20 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 71112026 11:33:17 AM
BADGE OR ID# 12490 ORI# WA0171300 TIME POLICE DISPATCHED', 10:21 PM TIME POLICE ARRIVED 10:25 PM
PART I PAGE IT]OF 3�
REPORT NO.! EH 16970 CASE# 26-4869 DATE AND TIME 06/21/26 22:20
OF COLLISION
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