HomeMy WebLinkAbout26-4943 TFFiNouCERA II I III 1 III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-4943 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 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 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 1357 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e✓ 18200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a SE 182ND ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2532632225 0 7 30
6� LAST NAME MANNING FIRSTNAME TAI MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 27127137TH AVE SE CITY KENT ST WA ZIP 980428087 z
'NEW ADDRESS
7❑ 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 9❑ Pi aT�S� W3393B sTATe WA VIN# JTEBU5JRXH5466245
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FR.. ro
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2017 TOYT 4RUNNE DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO THOMAS MANNING 21127137THAVE SE KENTWA 98042 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO TRAVELERS 618845554 203 1
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES NO CITATION# 6A0254828 INATTENTIVE DRIVING 1 o aorroM
15❑ NDING 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4258306445
16 a
LAST NAME BLAIOTTA FIRST NAME EMILY MIDDLE E
INITIAL
17❑ STREET ❑', 12934 SE 159TH ST CITY RENTON ST WA ZIP 980584738 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C.B. 08 _ 14 2008 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BDX4694 TATe WA VIN# KNAFZ4A84G5578043
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE KJA MODEL FORTE STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO VICTOR BLAIOTTA 12934 SE 159TH ST RENTONWA 98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 510220020IN 1U
9TOP
VE""LE CITATION# CHARGE o BOTTOMLEGALYYES N�25❑ J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH16975
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4943
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SCHULTEK LILYC
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
2921 TALBOT RD S RENTON WA 980555019 2532618153 SEXi F MMDOYyry 06 - 01 - 2008
PASSENGER Z WITNESS[I UNIT# 2 POS USE CLASS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' !1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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.
M.LEVERTON 06-26-26 12:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 71112026 6:31:22 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 4:87 PM TIME POLICE ARRIVED',Y:03 PM
PART I PAGE IT]OF 5�
REPORT NO. EH16975 CASE# 26-4943 OF COLLISION
06/24/26 13:57
OF CbLLI510N
NARRATIVE
1/gry raer stopped gry 2 hit gry stopped 3
CC
Within the city limits of Renton/King/Wa I responded to a 3 vehicle blocking crash at the 18100 block
of 108th Ave SE.
All of lane 2 and a small portion of lane 1 was blocked from the collision northbound on 108th Ave
SE.
I contacted the driver of unit 3 who told me he was stopped in traffic when he was hit from behind by
unit 2 who had been hit by unit 1. He did not complain of injury and damages did not require a tow
truck.
I contacted the driver of unit 2 who told me she was stopped, and emphasized she was really stopped
and had been for a minute or so when she was hit from behind by unit 1. She and her passenger did
not complain of injury and damages did require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL, which was issued just 2 months ago. He
told me that he did not have time to stop to avoid crashing into the back of unit 2 shoving her into unit
3. There was little to no tire marks left on the roadway from unit 1. He did not complain of injury and
damages did require a tow truck.
Unit 1 Dad arrived on scene and told me he was ging to recover dash cam video from his sons
vehicle/unit 1. Several minutes later Dad said he was unable to recover video and said he assumed
his son would be ticketed for the crash.
Based on the damages to unit 1 and 2, lack of tire marks from unit 1, unit 2 and 3 statement that they
were stopped and remaining lawful upon the roadway prior to the crash that unit 1 was not paying
attention and at the last minute braked and attempted to swerve to avoid contacting unit 2/3.
1 cited unit 1 ref RMC 10-12-25 Driver inattention 3 vehicle crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 6/26/2026
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EH16975
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 26-4943
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
UNIT# 3 �✓ � PEDESTRIAN YES NO
5 VEHICLE CYCLE OWNER ✓
0 7 29
LAST NAME DOSANJH FIRST NAME RAJVIR MIDDLE ',, S
INITIAL
STREET 30
NEW AnDRFSP 11919 SE 245TH PL CITY KENT ST WA ZIP 980309204
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YES NO NTERLOCK YES�NO� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 11 - 22 - 1999
7
ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE AZHO861 [TAT WA VIN# 1HGCP26349A191484
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 0 0 VEH.YEAR2009 MAKE HOND MODELACCORD STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1Ci P FROM TO
DAMAGE YES NO ✓ YES NO ✓
REGISTERED OWNER INFORAJVIR DOSANJH 11919 SE 245TH PL KENT WA 980309204 J 9 33
12 � SHADE IN DAMAGED AREA
3 4 FROM TO
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 861092321 q"i"Olx
IN EFFECT &POLICY# 1
VEHICLE 34
13 2 Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM
STANDING } 8 7
14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK 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 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
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.
X LEVERTON 06-26-26 12:06 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
BADGE O#I' APPROVED
/126 ORID# 2517 WA0171300 ACOBS 71/2 PAGE F OF 5
3000-345-013(R 11118)
REPORTNO.! EH16975 CASE# 26-4943 DATE AND TIME 06/24/2613:57
OF COLLISION
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PAGE 5 OF 5