HomeMy WebLinkAbout26-4609 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
2s-4sos 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CawsloN' 06 - 1-- 2026 1551 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HARDIE AVE SW
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a HARDIE AVE SW
2 0 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:2063832148 0 4 30
6� LAST NAME MAK FIRSTNAME JEN MIDDLE W 1 2 31
INITIAL
STREET ❑ 222 POWELL AVE SW CITY RENTON ST WA 21p 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES z❑
3
10❑ PI ATE 14 BPW9438 STATE WAa VIN#' 5TDZA23C85S270961
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR $ 1 33
12 2 5 VIN#' VIN#
>;. FROM TO
VEH.YEAR 2005 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 4 TOYT SIENNA VN DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 INSURANCE STATEFARM 5716286-F08.47A
IN EFFECT EFFEE CT &POLICY# 9TOP
VEHlcl.e CHARGE 1060TTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066014341
16 a
LAST NAME ELMI FIRST NAME ZAKIA MIDDLE
INITIAL
17❑ NEW STREETR 15803 S
7 E 257TH ST CITY COVINGTON ST WA ZIP 98042 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 08 _ 31 2005 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CVS8917 TATE 41
WA VIN# KL47LBEPSSB135001 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2025 MAKE BUIC MODEL ENVISTA STYLE UT DEHICLE AMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSURANCE
#E CO TRAVELERS 6163509922031IN 1GQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=OLLEIVBERG
(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 13031 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH22582
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4609
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'
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.
MATTHEW MOLLENBERG 06-14-26 09:15 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 712112026 1:07:54 PM
BADGE OR ID# 13031 OR]#' I WA0171300 TIME POLICE DISPATCHED! 4:13 PM TIME POLICE ARRIVED',4:17 PM
PART I PAGE IT]OF 4�
REPORT NO. EH22582 CASE# 26-4609 OF COLLISION
06/13/26 15:51
OF CbLLI510N
NARRATIVE
Renton Case #26-4609
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 06-13-2026 at approximately 1613 hours I was dispatched to a non-injury/blocking collision
located near Hardie Ave SW/Sunset Blvd SW. Dispatch advised the reporting party was involved in a
two vehicle non injury collision.
Officer Petty arrived and observed both vehicles in the roadway on Hardie Ave SW, both vehicles
were drivable, so he advised them to continue into the parking lot of Chevron located at 150 SW
Sunset Blvd. 1 arrived on scene and contacted the parties involved at Chevron.
I spoke with the driver of Unit 1 (WA/BPW9438) who identified himself by WA DOL as Jen W. Mak
(DOB 08-22-1947) who advised me of the following:
He was driving northbound in lane 2 of Renton Center Way onto Hardie Ave SW when he decided to
merge to his left into lane 1 shortly after continuing onto Hardie Ave SW. As he began his merge, he
collided with Unit 2 on his driver's side front quarter panel who was turning into the lane from the
west.
I spoke with the driver of unit 2 (WA/CVS8917) who identified herself by WA DOL as Zakia I. Elmi
(DOB 08-31-2005) who advised me of the following:
She was traveling westbound eastbound on Hardie Ave SW, she got to the stop sign at the
intersection of Hardie Ave SW/Hardie Ave SW and took a left to continue northbound. Lane 1 was
unoccupied, so she merged into that lane, as she entered the lane, she was struck by Unit 1 on the
passenger side of her vehicle who was merging into lane 1.
Based on the information gathered from involved parties and observations of the collision, the
proximate cause of the collision was the drivers of Unit 1 and Unit 2 both merging into lane 1.
I provided both drivers with an exchange of information.
This concludes my involvement with case #26-4609.
1 declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by M. Mollenberg 13031 on 06-14-2026 at 0909 hours in Renton,
WA.
PAGE 3 OF 4
REPORT NO. EH22582 CASE# ' 26-4609 DATE AND TIME 06/13/26 15:51
OF COLLISION
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