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Home My WebLink About25-1137 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 25-1137 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#OF OBJECT 1 ❑28 TRIBAL UNITS 03 STRUCK' UT/LITYPOLE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# CowsloN 02 - 1-- 2025 1558 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE 192ND ST BLOCK NO. e✓ 10623 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 107THAVESE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES �/No D:2535081580 30 6 INITIAL � LAST NAME YANISHAK FIRSTNAME NIKOLAY MIDDLE N 1 2 31 STREET ❑ 26518 114TH PL SE CITY KENT ST WA 2jp, 980307412 z= NEW ADDRESS 7❑ 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 z❑ 3 10❑ Pi aT�S� CGD5960 sTArI WAvrN# WDDSJ4GB5GN292784 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12❑ VIN#j UIN# RomM TO 34 13❑ VEH.YEAR2016 MAKE MERZ MODEL CLA STYLE VAMCLETOYES NOOpLSABLIN TLDYIIWhESSTOWING YEs❑ENO✓ DAMAGE IILLJJII REGISTERED OWNER INFO NIKOLAYYANISHAK 21118114THPL SE KENT WA 98030 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILI INSURANCE INSURANCE CO GEICO 6191200689 3 4 IN EFFECT &POLICY# 9TOP 36 VE—LE CHARGE 5 ECALLv ❑NO❑ CITATION# 1 o BOTTOM 15❑ L STANDING YES 8 7 6 UNIT 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWN ARTY ❑ DYES✓ NO OLD MET PHONE 16❑ LAST NAME QUEST FIRST NAME #A0510703 MIDDLE INITIAL STREET 17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑ 19 LLIICENS # STATE SEX U MMDDYY —❑_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ TArE LICENSE vIN# 41 PLATE# 42 22❑ PR TRAILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ 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 I vEwGLE ❑ ,J� CITATION# CHARGE25 GQ LEGALLY YES N`L J s � e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY 26 M.LEVERTON 2517 0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF64626 COLLISION REPORT III III III III III 111 1591972 CASE# 25-1137 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 02-05-25 07:47 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 2/11/2025 11:16:41 AM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 3:59 PM TIME POLICE ARRIVED',4:02 pry PART I PAGE IT]OF 5� REPORT NO. EF64626 CASE# 25-1137 OF COLLISION 02/04/25 15:58 OF CbLLI510N NARRATIVE blk/1 pole mailbox RTF Within the city limits of Renton/King/Wa I responded to a single vehicle crash into a cable pole and mailbox. The driver of unit 1 said he may or may not have blanked out of dozed off for a second. He said he had been up all night with a sick child and was just tired. He did not provide any additional information reference the crash. He did not complain of injury and made his own tow truck request. I notified Centurylink via phone that after an inspection from Renton Fire they needed to respond and make a priority assessment of their pole. I provided them the pole number and address where the pole was located. Renton Fire put caution tape around the pole and I left a copy of the info exchange in a yellow envelope for them. I provided a copy of the info exchange to the resident who had their mailbox damaged by unit 1. 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 2/5/2025 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EF64626 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 25-1137 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs� IN 29 MIDDLE' LAST NAME PONCE SILVERIO FIRST NAME ISIDRO INITIAL STREET 30 NEW AnDRFSP' 10623 SE 192ND ST CITY RENTON ST WA ZIP 98055 6 II 1 31 CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T DRIVER'S STATE I SEX U M��DYSYv' -� 2 LICENSE 7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE Y E ES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK 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 (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 LEwGLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv 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. M.LEVERTON 02-05-25 07:47 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVEDDATE 26 OI BADGE BY 2517 O#I',WA0171300 JACOBS 2/11/2025 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EF64626 CASE# ' 25-1137 DATE AND TIME 02/04/25 15:58 OF COLLISION 4 1 r t � 1 i e ``t P t @� �•� � 2� �s stt �� z� � t � 1 ti t t 3 4 z s PAGE 5 OF 5