HomeMy WebLinkAbout26-4711 TFFiNouCERA II I III 1 III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-4711 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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# ❑
cowsloN 06 - 1-- 2026 0751 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNET BNLVD N BLOCK NO. e✓ 320
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:2539294356 0 7 30
6� LAST NAME AL-HAWASLI FIRSTNAME MUHAMMAD MIDDLE S 1 1 2 31
INITIAL
STREET ❑, 25505 157TH AVE SE CITY COVINGTON ST WA ZIP 980424161 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ pl ATFBit BAJ1418 sTAr� WA urN# 4S46RBCC5B3394656
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# ROM ro
TRLR. YRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T VgyENp/(g GOVT.VEHICLE J 9 34
13 2 2011 SUBA OUTBA DAMAGE YES NO """- RS YES[:] NO✓
REGISTERED OWNER INFO MOHAMMAD AL HAWASLI 25505157THAVE SE COVINGTON WA 98042 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 983682130
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLv HIa.E 5 36
YES�No D CITATION# 6A0254825 CHARGE FOLLOW VEHICLE TOO CLOSELY io eorrom
STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES,/ No D:4255723523
VEHICLE
16 a CYCLE : OWNER
LAST NAME COATS FIRST NAME ARIANA MIDDLE A
INITIAL
17❑ STREET ❑', 19811 BOTHELL EVERETT HWY APT APT 816 CITY' BOTHELL ST WA ZIP 980128162 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RAII TED 38
INTERLOCK YES�NOR INTERLOCK YEs I I NOF YES t l NO[
19 DRIVER'S STATE WA ]SEX IF D.C... 03 _ 13 _ 2002 39
LICENSE# MMDDYY
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CJZ5558 TAre WA VIN1t ZACCJBC64HPG35408
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2017 MAKE JEEP MODEL RENEGA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ARIANA COATS 19811 BOTHELL EVERETT HWY APT APT 816 BOTHELL WA 980128162 D:4255723523 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO HELMSTED 2031620357IN 1 GD
LEGAL25
LY YES Nu
❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH18721
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4711
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.
M.LEVERTON 06-17-26 09:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/7/2026 4:08:59 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 7:82 AM TIME POLICE ARRIVED',7:55 AM
PART I PAGE IT]OF 4�
REPORT NO. EH18721 CASE# 26-4711 OF COLLISION
06/17/26 07:51
OF CbLLI510N
NARRATIVE
wht/unitl lane change 2 -3 rear blk/unit 2 lane change 3-2
CC
Within the city limits of Renton/King/Wa I responded to a two vehicle blocking crash near 320 Sunset
Blvd N.
I contacted the driver of unit 2 who told me she was merging from lane 3 into lane 2 when traffic in
front of her had come to a stop, which she did too. She told me she was completely stopped and was
almost completely in lane 2 but a small portion of the back end of her car was just inside lane 3. She
told me she was hit from behind by unit 1. She complained of of injury and was checked on scene by
Renton Fire. Damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was northbound lane 2 on
Sunset Blvd N when he was initiating a lane change to lane 3. He told me traffic stopped quickly in
front of him and he was unable to stop in time contacting unit 2 in the back of her vehicle. He did not
complain of injury and damages did require a tow truck.
I cited unit 1 ref RCW 46.61.145 Following too close 2 vehicle crash with minor injury 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 6/17/2026
PAGE 3 OF 4
REPORT NO.! EH18721 CASE# 26-4711 DATE AND TIME 06/17/26 07:51
OF COLLISION
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