HomeMy WebLinkAbout25-6121 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG11784oc� RA
COLLISION REPORT 1591971
CASE# 25-6121 2
INTERSTATE CITY STREET❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL AGENCY 4250 3
HIT&RUN COUNTY RD PRIVATE WAY ❑✓ NVOLVED ✓F CODING
2❑ TOTAL 1
TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
COLLISION'. 07 - 16 - 2025 1302 17 =.= S 8 W E IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
SE 168TH ST BLOCK NO. e 11505 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1 C------�. FEET e S 8 W
0 1 29
MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES NO ✓ 1 3 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET F-1 CITY ST ZIP' 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs Nb YEs NO
LCEENSE# STATE SEX U MMDDYY'. —=— t 32
8❑
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT ? HELM
USEET 9 CLASS 0 NATURE OF INJURIES 2
LICENSE 3
1 O PI ATF# STATE V(N
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# FBOM TO
TRLR TRlri 1 5 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BUN TOWED By GOVT VEHICLE
13 2 LNDR RANGE UT DAMAGE YES NO ✓ Yes No✓ m 34
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE El
CO 3 4
IN EFFECT &POLICY# 4TOP
v `LE CHARGE 5 36
Lec Ly YES❑NO❑ CITATION# 7 o BOTTOM
15❑ STM ING 1 7 6
�II El MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT Q2 VEHICLE CYCLE nWNFR YES NO �/ D:7028847951
16❑
LAST NAME AROS FIRST NAME JAMES MIDDLE G
INITIAL
17 F1 STREET ❑
?7650 134TH AVE SE APT L202 CITY RENTON ST, WA ZIP 98058 g 37
NEW AbbRESS
1$ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES No✓ (NTERLOCKYES No✓ rEs NO✓
19 LICEENSE# STATE AZ SEX M MMDDYY 09 0? 1986 ❑ 39
20❑ ON DUTY STATUS' AIRBAG'9 RESTR 9 EJECT 9 ' 0 HELMET 9 INJURY NATURE OF INJURIES ❑ 40
USE CLASS NONE
21 LICENSE I PLATE# CFD2013 rare WA vIN# 3VV1 B7AX7NM028922 41
22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2022 MAKE VOLJ( MODEL TIGUAN STYLE UTVEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO KYfSHACANN17650134THAVESEAPTL202 RENTONWA98058 D:7028847951 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GEICO 6194-37.01.74
IN EFFECT &POLICY# t 9TOP
Ve — ❑ CITATION# CHARGE tO BOTTOM
LEGnlly YES N J
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG11784
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6121
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME CANN KYISHA J
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O
17650 134TH AVE SE APT L202 RENTON WA 98058 7028847951 SEX LI MMDDYYvv
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z E' 2 POS. 3 2 1 1 USE CLASS 11
'NAME
LAsr F RST,MIDDLE INITIAL) UNKNOWN BOSTON
ADDRESS&PHONE# r
RENTON SEX' U
MMDDYYYY
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER WITNESS F-IUNIT# 2 POS. 9 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 R ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M � II
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF wJURIES
❑ Q POS USE CLASS �____ ---- I
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.
STEVEN FAJARILLO 07-21-25 07:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 7/22/2025 4:03:43 AM
BADGE OR ID# 9Y847 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 1:03 PM TIME POLICE ARRIVED 1:13 PM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG11784 CASE# 25-6121 O COLLI COLLISION TIME
OF 07/16/25 13:02
COLLI
NARRATIVE
25-6121
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 07-21-2025 1 was working as a police officer in the city of Renton. At approximately 1303 hours I
was dispatched to the report of a recent hit and run collision at 7-Eleven, 11505 SE 168th St, City of
Renton, County of King, WA. This incident was captured on my department issued Axon body
camera.
According to the notes in the call, a hit and run occurred. There were no injuries, and it was non-
blocking.
I contacted the driver of Vehicle 2 in a separate parking lot. The following is an account of events
according to him. He was driving in Renton when he got in a road rage incident with the driver of
Vehicle 1. Driver of Vehicle 1 was described as a white male, age 50's, a beard, and white shirt. The
driver of Vehicle 2 advised he would be able to recognize him if seen again. There was a partial plate
of"CMD" provided and was described as a white Range Rover SUV. Vehicle 2 pulled into the parking
lot of 7-Eleven, parked, and started in a verbal dispute with the driver of Vehicle 1. Vehicle 1 drove
into the open driver side door of Vehicle 2 and continued south on 116th Ave SE. There was no
attempt by Vehicle 1 to exchange information. There were no injuries to the driver of Vehicle 2 nor to
any passengers. The adult passenger advised she would not be able to recognize the driver of
Vehicle 1.
Vehicle 1 was not found on area check. I attempted to view video of the incident via the surveillance
cameras at 7-Eleven and they advised nobody was there to operate them. I provided a case number
and advised they call police when their manager arrived. They never called. There was damage to
the driver side door hinge and an impact mark on the latch side. I photographed Vehicle 2 and
uploaded the pictures to Evidence.com.
Vehicle 2 was drivable.
The driver of Vehicle 2 advised he did not want to press charges for any crime nor participate in
prosecution. I provided him with a case number.
Due to the victim of this hit and run not wanting to participate in prosecution I did not further
investigate. There was not enough information to establish probable cause for a suspect in this hit
and run.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 07/21/2025 @ 0750 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EG11784 CASE# 25-6121 DATE AND TIME i 07/16/25 13:02
OF COLLISION
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