HomeMy WebLinkAbout25-8820 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CRSE# 2$-8820 2 0 4
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4100 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 04 STRUCK M/SC OBJECT OR DEBRIS ON ROAD
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 10 - 11 - 2025 1915 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AV NE BLOCK NO. e✓ 1700
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FEET MILES e S B W e NE 18TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2533359798 1 2 30
6� LAST NAME YADROVA FIRSTNAME SVITLANA MIDDLE 1 2 31
INITIAL
STREET ❑✓ 2214 VASHON AVE NE CITY RENTON ST WA Zjp, 98059 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs �/NO INTERLOCKYEs NO Z/ YES R No�/
$ LICIENSE# STATE yyq SEXI F MMDDVY' 11 - 14 - 1983 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU SE CLASSS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATNES# CTV6756 sTAr WAu N# 2FMDK49C87B629723
0 TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 34
13 4 D OW FORD EDGE DAMAGE YES NO �MEYER 7 5 YES[:] ✓
REGISTERED OWNER INFO SVITLANA YADROVA2214VASHONAVENE RENTONWA98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NONE <1�3 4
IN EFFECTPOLICV# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO CITATION# 5A0663866 OP MOT VEH W/OUT INSURANCorrom
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2066923162
16 a
LAST NAME BARNES-CREDIT FIRST NAME ROLANDA MIDDLE
INITIAL
17❑ STREET ❑', 1700 UNION AVE NE CITY RENTON ST WA ZIP 980593900 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[—] LDI IVEW # STATE WA ]SEX IF M D.C.B. 07 01 1959 0 39
WELMET INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHR8373 TAre WA VIN# 5UXTR9C52KLP90464
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2019 MAKE BMW MODEL X3 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES 1/ NO GENE MEYER YES NO
REGISTERED OWNER INFO DEITRA CREDIT 210 LOTTIE ST BELLINGHAM WA 98225 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 5444072B2647BIN STOP 5
VE"LE ❑ N,J� CITATION# CHARGE to BOTTOM
LEGALLY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG37520
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8820
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CREDIT DEITRA R
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1700 UNION AVE NE RENTON WA 980593900 SEXi F MMDDYyry 01 - 03 - 1988
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 POS 3 AIRBAG 6 RESTR. 4 EJECT USE CLASS 7 HEAD E OF INJ ACK
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Id I DOB
E MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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'
Unit 1 speeding northbound along 1700 block of Union Av NE. Unit 2 merging into traffic onto Union
Av NE, facing west making a left turn south from the driveway of 1700 Union Av NE. Unit 1 strikes
Unit 2 causing major disabling reportable damage to both Unit 1 and Unit 2. The impact of the crash
forces Unit 2 to rotate to the right, northbound and ends up facing northboun on Union Av NE. Unit 1
careers diagonally and ends up in the front yard of 1807 Union Av NE, causing a secondary collision
with Unit 3, which was legally parked, unoccupied, within the driveway at said property.
Unit 3 sustained minor reportable damage to driver side. Unit 4 resident and property owner of Unit 3
also sustained shrubbery and yard damage from the path Unit 1 took to enter into said property. No
injuries reported save for front passenger of Unit 2, who was assessed on scene by Renton Fire and
later self transported to hospital for further treatment. Unit 1 driver was the proximate cause of the
collision due to her excessive speed and for the fact that it was illegal for Unit 1 driver to have been
driving in the first place as a check of her WA DOL status returned with a pre trial ignition interlock
device which was not affixed to Unit 1 at the time of collision. Unit 1 driver also did not have proof of
vehicle insurance. Unit 1 driver was assessed on scene and did not exhibit any signs of impairment.
Unit 1 driver cited for IID violation and no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 10-11-25 09:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 10/14/2025 2:31:24 PM
BADGE OR ID# 12651 OR]#' ' WA0171300 TIME POLICE DISPATCHED 7:16 PM TIME POLICE ARRIVED',7:20 PM
PART I PAGE IT]OF 4]
SUPPLEMENTAL REPORT NO. EG375520
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT (CASE# 25-8820
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GWVR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL-
PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES� IN
1 4 29
LAST NAME NONE FIRST NAME MIDDLE
INITIAL
STREET 30
NEW AnDRFS CITY RENTON ST ZIP
6 [2 P
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES NO zERLOCK YES❑N0� YES N
DRIVER'S STATE I SEX U M��DVSYv' —� 2
LICENSE
7
ON DUTY STATUS AIRBAG 2 RESTR. 1 EJECT 1 HELMET 9 INJURY 1 NATURE OF INJURIES
F�
USE CLASS
8 ❑ 1 32
LICENSE I C23538S [TAT INA VIN# 1FTFWlETODFA93011
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1C P FROM TO
2013 FORD F150 TR DAMAGE vES NO �/ YES NO
33
SHADE IN DAMAGED AREA
REGISTERED OWNER INFOJESUS RENTERIA CORRAL 1807 UNION AVNERENTONWA98059 D:4256524447 m 12
7GQ
j4 FROM TO
LIABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# tEHIELE 34
13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE
STANDING 4 MOT{7R PEDAL PROPERTY a e
DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN1:1 OWNER YES NO D:4256524447
36
15 ❑ LAST NAME RENTERIA CORRAL FIRST NAME 1JES US MIDDLE
INITIAL
16 ❑ STREET ❑; 1807 UNION AV NE CITY RENTON STI WA Z!P 98059
NEW AnnR".%
CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
17 ❑ INTERLOCK YES NO INTERLOCK YEs N. YEs NO ElDRIVER'S STATE SEX U moo 37
D,O
18 ❑ LICENSE# MMDDYYY
ON DUTY STATUS AIRBAG RESTR, EJECT HELMET INJURY NATURE OF INJURIES ❑ 38
USE (CLASS
19 ❑ 39
LICENSE VIN#
PLATE# rnr
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
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 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
Lec E
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.
HANSEN HSU 10-11-25 09:19 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12651 O#I',WA0171300 APPROVED BY
10/14/202 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. EG37520 CASE# 25-8820 DATE AND TIME 10/11/2519:15
OF COLLISION
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