HomeMy WebLinkAbout26-5526 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-5526 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 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# ❑
cawsloN 07 - 1-- 2026 1545 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 41ST ST BLOCK NO. e✓ 616
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067080595 0 11
30
6 LAST NAME MORA OLEA FIRST NAME JAQUELINE MIDDLE N 1 2 31
INITIAL
STREET ❑, 3039 S 154TH ST APT B202 CITY SEATAC ST WA 2jp, 981882149 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CHR8757 sTArI WAvIN# 1N4At3APXEC287528
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2014 NISS ALTIMA DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO JAOUELINEMORA OLEA 3039 S 154TH STAPTB202 SEATAC WA 981882149 D:2067080595 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 912P
VEHicLE CHARGE 5 36
LEGALLY YEs❑NO CITATION# 6A0254838 FAIL YIELD PRIVATE RD MOTOR o eorrom
15❑ STANDING <1 7 6
�IJNIT
MOTOR PEDAL-. 'PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLDMET PHONE
02 VEHICLE CYCLE: OWNER YES�/ NO
16 a
LAST NAME SKINNER FIRST NAME KEITH MIDDLE R
INITIAL
17❑ STREET ❑', 19310 141 ST AVE SE CITY RENTON ST WA ZIP 980580000 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 LDIIVEW # STATE WA SEX M M .C... 11 21 1977 El 39
JJ
20 F1
ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 40
USE CLASS TBD
21❑ LICENSE I BXH3481 TArE WA VIN# 1C3EL65R53N524893
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2003 MAKE CHRY MODEL SEBRING STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KEITH SKINNER 19310141ST AVE SE RENTON WA 980580000 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU8 POLICY#E CO PROG TBDIN IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 6
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. EH24211
COLLISION REPORT III III III III III 111
1591972 CASE# 26-5526
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 10:21:23 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 3:45 PM TIME POLICE ARRIVED',3:49 PM
PART I PAGE IT]OF 4�
REPORT NO. EH24211 CASE# 26-5526 OF COLLISION
07/15/26 15:45
OF CbLLI510N
NARRATIVE
gry/1 It from ikea blu lane 1 eb
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash near the 600 block
of SW 41 st St.
When I arrived I asked for additional unit to assist with traffic as one involved vehicle was blocking EB
lane 1 and the other was blocking WB lane 1. Because people were not slowing to go around they
would drive into the head on lane to speed by. Eventually we had all lanes of traffic shut down.
I contacted the driver of unit 2 who told me he was eastbound on SW 41st St lane 1 when out of the
blue unit 1 pulled from the Ikea parking lot crashing into the passenger side of his vehicle. He lost the
ability to steer and his vehicle veered into lane 1 westbound. He did not complain of injury and
damages required a tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL. She told me she was attempting to make a
left turn from the Ikea driveway/parking lot onto SW 41st St and did not notice unit 2 driving directly
into the side of his vehicle. She did not complain of injury. She had an unknown infant in her vehicle
she would only ID as her daughter. Renton Fire responded to precautionary check the infant. Unit 1
required a tow truck for damages.
I cited unit 1 ref RCW 46.61.205 FTYROW from private drive onto roadway 2 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 7/16/2026
PAGE 3 OF 4
REPORT NO. EH24211 CASE# 26-5526 DATE AND TIME 07/15/2615:45
OF COLLISION
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