HomeMy WebLinkAbout26-5520 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-5520 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 7 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 07 - 15 - 2026 1345 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW GRADY WAY BLOCK NO. e✓ 1120
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1501. 00 FMILES EET e S ❑ W e OAKESDALE AVE SW
0 3 29
U '�01 VEHtOCLE CELL. ❑ YESAGE NHORE✓LD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
DRIVERS
STATE SEX D - 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[9 PI ATE#
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 3 1 33
12❑ VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LEGALLv Ye8❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:4243526136
16 2
LAST NAME AYSON FIRST NAME LOGAN MIDDLE ID
INITIAL
17 STREET❑ NEW ADOREss❑' 1900 PIERCE AVE NE#A CITY RENTON ST WA ZIP 98056 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑
19[ LDIIVE # STATE SEX M M .C.B. 11 19 _ 2001 El 39
20 ON DUTY STATUS 1 AIRBAG RESTR EJECT 1 HELMET 7 INJURY 6 NATURE of INJURIES 40
USE CLASS RIGHT LOWER LEG
❑21❑ TATE 41
LICENSE VIN# `1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26 4 9 M.LEVERTON 2517 0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH24208
COLLISION REPORT III III III III III 111
1591972 CASE# 26-5520
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
PM 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 07-16-26 02:31 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 7/27/2026 10:19:28 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 1:45 PM TIME POLICE ARRIVED',1:47 PM
PART I PAGE IT]OF 4�
REPORT NO. EH24208 CASE# 26-5520 OF COLLISION
07/15/26 13:45
OF CbLLI510N
NARRATIVE
unit 1 right turn eb across apron suv gray/ male older 70-ish asian left for dr appt right lower leg
RTF
Within the city limits of Renton/King/Wa I responded to a car v bicycle at 1120 Oakesdale Ave SW.
I contacted the bike rider who was being treated by Renton Fire. He was complaining of right leg
pain. Renton Fire transported him to VMC-ER for further checks to what looks like some abrasions
and bruising just below his right knee.
I contacted the bike rider in ED room 25. He provided me the following. He was riding on the
sidewalk eastbound on the north side/west bound traffic side. When unit 1 an unknown type gray
SUV westbound turned into the parking lot of Shell at the same time he was crossing the driveway
apron. The SUV pinches his leg between his bicycle and bumper. He told me a 70yo asain male
said he was sorry and was later for a doctor appt and left the area. No information was exchanged
between the two adults.
No witnesses provided any additional information and the manager of Shell gas station said there
was no video footage reference this contact.
Damage to the bicycle looked like a bent rear fender and damage to the single seat pad.
Information/Insurance only.
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 7/16/2026
PAGE 3 OF 4
REPORT NO. EH24208 CASE# ' 26-5520 DATE AND TIME 07/15/26 13:45
OF COLLISION
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