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HomeMy WebLinkAbout25-8829 c�TRAFic" REPORT NO EG43540t o 4 27 )STATE COLLISION REPORT 1591971 ❑ FIRE ❑ �/Q$E# 25-8829 2 5 0 INTERSTATE CITY STREET ✓ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4200 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TRIBAL UNITS#OF 03 SO7RUCK FENCE BJECT 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsfoN' 10 - 12 - 2025 0300 17 =.�� S H W e OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NONINTERSECTION TAYLOR AVE NW BLOCK ST e 300 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 100 00-1 MILES N E FEET e✓ S 8 W e NW 3RD PL 0 1 29 MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ vEs Vl No D:4254639985 30 6 LAST NAME CARDONA-SAMAYOA FIRST NAME JYMY MIDDLE J t 1 2 31 INITIAL STREET ❑ 3030 NE 10TH ST APT 409 CITY RENTON ST WA ZIP 98056 2 NEW AbDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO✓ INTERLOCKvEs No✓ YES D NoF,/ 8 �CIENS # STATE WA SEX M MMQCSYY' 02 — O6 — 2004 32 9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELM USEET 2 CLASS 1 NATURE of INJURIES 2 I INJURY LICENSE, CTT0085 STATE WA VN# 4T1BE46K19U352127 3 10 PI ATF tt TRAILER STATE TRAILER ,STATE 11 3 0 PLATE# PLATE# ROM TO rRLR TRLR 1 5 33 12 VIN# VIN ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN GOVT VEHICLE m 34 13 4 2009 TOYT CAMRY SD DAMAGE YES ✓ NO ��riERS TOWING YEs� No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO �g_ IN EFFECT &POLICY# 68`SOP vewc�e CHARGE BOTTOM ❑ 36 ecnur Yes❑NO❑ CITATION# SA0820913,5A0820913 OP MOT VEH W/OUT INSURANCE,NO 15❑ TM ING �y MOTOR PEDAL PROPERTY WE THR OLD MET PHONE UNIT©2 PEDESTRIAN ✓ VEHICLE CYCLE' OWNER YES�/ NO 16❑ LAST NAME SUNRISE VIEW CONDOS FIRST NAME MIDDLE' INITIAL STREET ❑ 17 ❑ 114 NW 3RD PL CITY RENTON ST, WA ZIP 98057 4 37 NEW AbORESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSP©RTED: ❑ 38 INTERLOCKYES No INTERLOXYEs 0No vEs No' 19 LICEENSE# STATE SEX U MMDDYY 39 HELMET I INJURY' NJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS NATURE of I ❑ 21 PLATE# rare vIN# 41 22❑ [TILER TRAILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. GOV H 44 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY I 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP vewae YES❑ N`,.[—I CITATION# CHARGE tO BOTTOM L-1— 25 a a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MATTHEW MOLLENBERG 13031 WA0171300 PART A PAGE 01 OF 3000-345-159(R 11/181 POLIICFETRAFFICN CORRECTION REPORT NO. EG43540 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8829 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INTTIAL) ADDRESS&PHONE# SEX' D.O.B. - [----------� MMDDYYYY PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. - L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j 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 10-12-25 04:50 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 7691 1 1013112025 5:56:52 PM BADGE OR ID# 13031 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:09 AM TIME POLICE ARRIVED 3:14 AM PART B 3oDo-345-,ao(Rtrras) PAGE 27 OF 57 REPORT NO.` EG43540 CASE# 25-8829 O COLLI COLLISION TIME OF 10/12/25 03:00 COLLI NARRATIVE Renton Case #25-8829 Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 10-12-2025 at approximately 0309 hours I was dispatched to a motor vehicle vs. tree collision at Sky Lanai Apartments located at 360 Taylor Ave NW. Dispatch advised the reporting party is the uncle of the involved driver. The vehicle had left the roadway and struck a tree near the dispatch location. I arrived on scene at 0314 hours and observed unit 1 bearing WA/CTT0085 had left the roadway, drove through the landscaping of the Sky Lanai Apartments and continued through a fence of the neighboring property (114 NW 3rd PI) and struck a tree. I contacted the driver of unit 1 who identified himself by WA DOL as Jymy J. Cardona-Samayoa (DOB 02-06-2004). He was Spanish speaking, so language line was utilized for communication. Jymy advised he was on his way home from work, traveling southbound on Taylor Ave NW when he lost control of his vehicle and left the roadway, causing the collision. He works for a moving company and had driven to Oregon and back today. He was still on his way home from work at the time of the collision, advising he was tired from the day. I did not establish probable cause for Jymy being under the influence of drugs/alcohol from our interaction. After running Jymy's information through dispatch I was advised that he does not have a valid drivers license. He was also unable to provide insurance as he advised he just bought the vehicle and has not purchased insurance yet. He was advised that he would be receiving a citation in the mail for operating a motor vehicle without a valid driver's license and operating a motor vehicle without insurance. His uncle had his tow truck on scene, he towed the vehicle and cleaned up the roadway of debris. Renton Fire Department was dispatched to the scene to assess any damages to power lines or utility equipment. No damages were found. There was no damage to government property. I took images of the vehicle and property damages at the scene of the collision and uploaded them to evidence.com under Renton Case #25-8829. This concludes my involvement in Renton Case #25-8829. 1 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 10-12-2025 at 0430 hours in Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EG43540 l�� NRCoI COLLISION TRAFFIC ! CASE# 25-8829 1 27 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD GWVR NO NUMBER SOURCE: AXLES + NAME IF 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE UNIT : 3 PEDESTRIAN �' YEs� No D:2064571795 5 VEHICLE CYCLE OWNER MIDDLE 29 LAST NAME SKY LANAI APARTMENTS FIRST NAME INITIAL STREET 30 NEW ADDRFR 360 TAYLOR AVE NW CITY RENTON ST WA ZIP 98057 6 ❑ PRESENT MEDICALTANSPORTED 1 31 CDL IGNITION REQUIRED 1GNi71CN INTERLOCK YES: NO ..INTERLOCK YES[]NO I .YES N DRIVER'S STATE SEX U MMDDYBYY LICENSE; 7 ON DUTY STATUS: AIRBAG RESTR. EJECT HELMET INJURY NATUREOFINJURIES USE CLASS 8 ❑ LICENSE VIN 1 32 PLATE# TAT 9 TRAILER TRAILER 2 PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.# VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TO WE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 � SHADE IN DAMAGED AREA LIABILITY INSURANCE❑ INSURANCE CO 4 FROM TO TO, IN EFFECT &POLICY# 34 13 YES NO CITATION# CHARGE 1080TTC7M ecauv sTnNoiNc MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YESF-1 NO 15 LAST NAME FIRST NAME ❑INITMIDDL ALE 36 16 ❑ STREET CITY ST! ZIP NEW ADDRESS" GDL IGNITION REOUIRED .IGNITION PRESENT MEl71CAL TANSPORTED INTERLOCK YES NO INTERLOCK YES NO 'YES NO 17 37 DRIVERS 11 ICENSEE# STATE SEX MD,O _� 18 ❑ URE OF INJURIES 38 ❑ HELMET INJURY NAT ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS 19 ❑ ❑ 39 LICENSE viN PLATE# TAT # 20 ❑ TRAILER TRAILER ❑ 40 PLATE#; STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN#; VIN#+. 42 22 VEH.YEAR MAKE I MODEL I STYLE I VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# tK-99 5 44 vewc�e ❑ ❑ CITATION# CHARGE 24 IEG_ VES NOSTIWDING6 3 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MATTHEW MOLLENSERG 10-12-25 04:50 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE 1 OR ID# 13031 O#RI WA0171300 APTIBEAU 10131/202 PAGE OF � 3000-345-013 IN 11/18) REPORT NO. EG43540 CASE# 25-8829 DATE AND TIME i 10/12/25 03:00 OF COLLISION F t t 2 ?: ti. F tw Li to i 4 PAGE 5 OF 5