HomeMy WebLinkAbout25-9804 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
2s-ssoa 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 2$
6 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 11 - 11 - 2025 1718 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 44TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LAKE WASH BLVD NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2067565757 1 2 30
6 LAST NAME GARCIA HERRERA FIRSTNAME ADA MIDDLE I Y 1 1 2 31
INITIAL
STREET ❑✓ 1412 JEFFERSON AVE NE CITY RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 05 1- 12 - 1991 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 P1 ATNES# CLY0077 sTAr WAuN# JTDKN3DU1A0152847
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
FTRL-R TPILF1 1 5 33
12 2 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2010 TOYT PRIUS P4 DAMAGE YES NO ves❑ No
REGISTEREDOWNERINFO ADA GARCIA HERRERA 1412 JEFFERSON AVE NE RENTON WA 98056 D:2067565757 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
1 LIABILITY INSURANCE INSURANCE CO 4
14 ❑ NO INSURANCE
IN EFFECT M:
POLICY# STOP
vewCLE CHARGE 5 36
LEGALLY res No clTAnoN# 5AO823401 OP MOT VEH W/OUT INSURANCE o eorroM
15❑ STANDING 8 7 6
MOTOR PEDAL PROPERTYPROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:2063541614
16 2
LAST NAME NIKOLYUK FIRST NAME YELENA MIDDLE V
INITIAL
17 STREET I❑ S❑' 1707 NE 27TH PL CITY' RENTON ST WA ZIP 98056 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs❑NOF YES
❑NoF,/
19[ LDI IVERI # STATE WA ]SEX IF M D.O.B. 01 15 _ 1960 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ LICENSE I PLA E# BEP4386 TArE WA vIN# 4T1BF1FK4GU141187 1
42
22❑ PLATE# STATE PLATE# STATE
T
23❑ 43
IN# IN RLR
#.UIN#. '
VEH YEAR 2016 MAKE TOYT MODEL CAMRY STYLE P4 VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO YELENA NIKOLYUK 1707 NE 27TH PL RENTON WA 98056 D:2063541614 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSURANCE
#E CO GIECO 6230741925IN 1UR
5
VEHICLE ❑ ,.I—I CITATION# CHARGE LEGALLY YES N25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
RAYMOND WATSON 13127 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG58043
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9804
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.
RAYMOND WATSON 11-16-25 06:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 12/12/2025 10:11:52 AM
BADGE OR ID# 13127 OR]# WA0171300 TIME POLICE DISPATCHED' 5:22 Pry] TIME POLICE ARRIVED',5:27 PM
PART I PAGE IT]OF 4�
REPORT NO. EG58043 CASE# 25-9804 OF COLLISION
11111/25 17:18
OF CbLLI510N
NARRATIVE
25-9804
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 11/11/2025 at approximately 1722 hours, myself, Officer R. Watson, was dispatched to an
accident with no injuries and non-blocking, at McDonalds, 1705 NE 44th ST, within the City Limits of
Renton, County of King, State of Washington.
Dispatch notes stated that there were two vehicles involved, non-blocking, no injuries, and one of the
drivers did not have insurance.
When I arrived on scene, I saw two vehicles in the parking lot of the address with damage.
Unit#1 driven by Ada Y. Garcia Herrera (DOB 05/12/1991) verified by WA DOL photo, stated that
she was driving a Red 2010 Toyota Prius, WA plate # CLY0077. There were no other passengers in
the vehicle. Ada said through use of language line, that she was in the roundabout when unit#2
entered and collided with her vehicle. Ada said she had no injuries and declined aid. When I asked for
Ada's license, registration and insurance she was able to provide me with her license and registration
but said she did not have insurance on the vehicle. Unit#1 had moderate damage to the right side of
the vehicle, no airbag deployment and was able to be driven from the scene.
Unit#2 driven by Yelena V. Nikolyuk (DOB 01/15/1960) verified by WA DOL photo, stated she was
driving a Black 2016 Toyota Camry, WA plate #BEP4386. There were no other occupants in the
vehicle. Yelena said that she visually cleared the circle, pulled into it when unit#1 collided with her.
She said she was not sure where unit#1 came from. Yelena said she had no injuries and declined
aid. Unit#2 had moderate left front side damage, no airbag deployment and was able to be driven
from the scene.
An exchange of information was completed and provided to each party. A citation for driving without
valid insurance was forwarded to the Renton Prosecutors Office, cite #5A0823401, for Ada.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer R. Watson #13127 11/16/2025 1831 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EG58043 CASE# ' 25-9804 DATE AND TIME 11/11/25 17:18
OF COLLISION
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