HomeMy WebLinkAbout25-7313 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG22707OLCERA
COLLISION REPORT 1591971
CASE# 25-7313 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 08 - 21 - 2025 1843 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
LAKE YOUNGS WAY SE
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e SE 16TH ST
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2062274972 0 1 30
6 LAST NAME DUNCAN FIRST NAME ANTHONY MIDDLE P 1 1 2 31
INITIAL
STREET ] 1309 HARRINGTON AVE SE CITY; RENTON ST WA ZIP; 980583833 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKVES NO✓ YEs NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 02 - 07 - 1971 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, C45136P STATE WA VIN#; 1FTYRIZMlHKBO9958 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE ROM TO 11 3 5 PLATE# PLATE#
TRLR TRLR 7 1 3 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2017 MAKE FORD MODEL TRANSI STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO BLACK SHEEP ELECTRIC LLC 24228155TH AVE SE SNOHOMISH WA 98296 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 3 4
14 PACIFIC CREST SERVICES AZG68526203
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE t a BOTTOM 36
Lemur yes❑NO❑ CITATION# HARE 5
15❑ sTnNowc 7 e
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2064238060
16�
LAST NAME BACAB CATZIN FIRST NAME GADY MIDDLE' G
INITIAL
17 F1 STREET ❑
❑ 1411 GRANT AVE SAPT/204 CITY RENTON ST, yyq ZIP 98055 4 37
NEW ADDRESS
18❑ CDL IGNITION REt1UIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38
INTERLOCK YES NO✓ INTERLOCK YES R N.FV YES NO✓
19� DRIVERS STATE WA SEX U D-O.B. 12 07 1980 � 39
LICENSE# hAMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 7 HELMET 2 INJURY NATURE OF INJURIES 40
USE CLASS LEFT KNEE AND BACK PAIN
21 LICENSE CCM1829 rare WA vIN# 4T4BF1FKOGR529135 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
TOWED BY GOV HI 44
VEH.YEAR 2016 MAKE TOYT MODEL CAMRY STYLE VEHICLE
TOWED✓ No BLIN BANKERS ves No✓
24
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 987249949
IN EFFECT &POLICY# t 9TOP
"IHIC
L,EIL�e YES❑ NJ—I, CITATION11 CHARGE tO BOTTOM
6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW MOLLENBERG 13031 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG22707
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7313
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) BENITES-BACAB KEVIN E
ADDRESS&PHONE#
1411 GRANT AVE S APT I204 RENTON WA 98055 SEXi M MMDooYBYYY 01 IT
31 — 2014
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 3 2 4 1 USE 2 CLASS !1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
:.(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I 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 08-22-25 04:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 8/26/2025 7:16:49 PM
BADGE OR ID# j 13031 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:44 PM TIME POLICE ARRIVED i 6:47 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG22707 CASE# 25-7313 O OF COLLISION TIME 08/21/25 18:43
NARRATIVE
Renton Case #25-7313
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 08-21-2025 at approximately 1844 hours I was dispatched to an unknown injury accident between
2 motor vehicles at the intersection of Lake Youngs Way SE/SE 16th St. Dispatch advised that the
vehicles involved were a black Toyota Camry bearing WA/CCM1829 and a white Ford Transit
bearing WA/C45136P.
I arrived on scene at 1849 hours and contacted the driver of WA/CCM1829 who identified herself by
WA DOL as Gady G. Bacab-Catzin (DOB 12-07-1980). She advised that she was feeling some pain
in her left knee and back. Renton Fire Department was already dispatched to the scene to assess
injuries from the collision. She advised she was traveling northbound on Lake Youngs Way SE
entering the intersection at SE 16th St when the vehicle bearing WA/C45136P entered the
intersection and struck her vehicle at the driver's door/front drivers side tire in the center of the
intersection. North and Southbound traffic have the right of way at this intersection. Her son was in
the passenger seat, who identified himself as Kevin E. Benites-Bacab (DOB 01-31-2014), Kevin
stated he did not sustain any injuries. Both occupants stated they were wearing their seatbelt and
airbags were not deployed.
I then contacted the driver of WA/C451361P who identified himself by WA DOL as Anthony P. Duncan
(DOB 02-07-1971). He advised he was sore but did not feel he was injured. He stated he was
traveling eastbound on SE 16th St when he came to a stop at the stop sign at the intersection of Lake
Youngs Way SE/SE 16th St. He looked to his right and then left and then entered the intersection
traveling eastbound. He advised he did not see Gady's vehicle because he failed to look to his right
again before he started driving. He stated he was wearing his seatbelt and airbags were not
deployed.
I took images of both vehicles at the scene of the collision and uploaded them to evidence.com under
Renton Case #25-7313.
There is no further information at this time.
I 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 08-21-2025 at 2140 hours in Renton,
WA.
PAGE 3 OF 4
REPORT NO. EG22707 CASE# 25-7313 DATE AND TIME 08/21/25 18:43
OF COLLISION> '
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