HomeMy WebLinkAbout26-25 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE# zs-zs 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 01 - 01 - 2026 2125 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
126TH AVE SE BLOCK NO. e✓ 16100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4253369050 1 4 30
6� LAST NAME FREEMAN FIRSTNAME JOHN MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 3240 SE 12TH ST UNIT 1037 CITY RENTON ST WA ZIP' 980583890 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I INTERLOCK YES[:]No NTERLOCKYEs NO✓ YES R No
8❑ LDRIVER # STATE WA SEX'M MID
-O B 07 — 14 — 2006 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10❑ Pi ATE 14 CSM0638 sTAr WAu N# 3KPF34AD5LE246211
5
----� TRAILER STATE PLAT Eft STATE
11 2 PLATE# PLATE# FROM ro
TRLR. TRLR 5 1 33
12 0 0 VIN#' VIN#
2020 KIA FORTE 4D plsA FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO ANDREA GIJCINSK13.0 SE 12TH ST UNIT 1037 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO PROGRESSIVE 996435495 3 4
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STAIN.D'ING 8 7 6
UNIT VE IOCLE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO A. OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS RIVER# STATE SEX U MMDDYY 39
WELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑21❑ PLATE# BST9875 TAre WA VIN# 2C3CDXCT6KH754426 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE DODG MODEL CHARGE STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO✓ YES NO✓
REGISTERED OWNER INFO BRIAN LOMBARDI 16156126T AVE SE RENTON WA 98058 D:2067933819 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 478947102047CIN 1 VEHICLE ❑ ,.II CITATION# CHARGE �,�
LEGALLY YES N
25 Q.
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
ROBIN SMITH 12986 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG65340
COLLISION REPORT III III III III III 111
1591972 CASE# 26-25
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.
ROBIN SMITH 01-01-26 10:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 1/3/2026 2:07.01 AM
BADGE OR ID# 9Y988 OR]# WA0171300 TIME POLICE DISPATCHED 9:25 PM TIME POLICE ARRIVED',9:34 PM
FART I PAGE IT]OF 5�
REPORT NO. EG65340 CASE# 26-25 OF COLLISION
01101/26 21:25
OF CbLLI510N
NARRATIVE
26-25
Unless otherwise stated, the following occurred in the City of Renton, County of King, State of
Washington.
On 01-01-2026 at approximately 2129 hours I was dispatched to a non-injury, blocking, three vehicle
collision in the 16100 block of 126th AVE SE. The reporting party said that a vehicle ran into their two
parked vehicles, and they were concerned the driver was under the influence of alcohol or drugs.
Upon arrival, I contacted the involved parties and confirmed no one was injured. I collected the
involved parties driving documents and their independent recollection of events leading up to the
collision.
The driver of Unit#1 said he was driving northbound in the 16100 block of 126th AVE SE when he hit
a groove in the road and when he swerved out of it to the right, he oversteered and collided into the
rear driver side corner of Unit#2. 1 did not smell any odor of intoxicants or observe any indication of
intoxication from the driver of Unit#1. Unit#1 sustained damage to the passenger front corner of the
vehicle.
The registered owner of Unit#2 and Unit#3 was on scene. He owned both vehicles. He was inside
his house when he heard a crash outside. When he came outside, he saw that Unit#1 had collided
with the rear driver side corner of Unit#2. Unit#2 was now pushed into the rear of Unit#3. The rear
of Unit#3 had minor damage. His vehicles were unoccupied at the time of the collision.
I find the driver of Unit#1 to be the proximate cause of the collision for violating RCW 41.61.140
driving on roadways laned for traffic. He violated this when he swerved outside of his lane, colliding
with two legally parked vehicles on the east side of 126th AVE SE. I did not cite the driver of Unit#1.
I took photographs of all vehicles and uploaded to Axon.
An exchange of information was provided to both parties. Unit#1 was able to drive away from the
scene.
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 Robin Smith #12986 on 01/01/2026 @ 2228 hours in Renton, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG65340
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 26-25
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST' ZIP'
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 : UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET 30
NEW AnnRFrtP. CITY ST ZIP
6 g
CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES No NTERLOCK YES❑N0� vES N
DRIVER'S STATE I SEX U M��DVSYv' -� 2
LICENSE
7
ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES
F�
USE CLASS
8 ❑ 1 32
LICENSE I CRG1028 [TAT WA VIN# 7FARWIH93KE012506
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 O O VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1C P FROM TO
2019 HOND CRV SV DAMAGE YES NO YES NO
REGISTERED OWNER INFOBRIAN LOMBARDI 16156126TH AVE SE RENTON WA 98058 D:2067933819 m 33
12 � SHADE IN DAMAGED AREA
3 4 FROM TO
LIABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# t 9 1"01?
VEHICLE 1 o BarroM 34
13 IEcnuv YES N001
CITATION# CHARGE
STANDING } 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER
YES AGE NOHRESHOLD MET PHONE El
35
PEDESTRIAN
15 LAST NAME FIRST NAME INIMIDDLETIAL ❑ 36
STR
16 STREETEETAnnR"[-] CITY ST ZIP
CDL IGNITION REdUiREO IGNITION PRESENT MEDICALTANSPORTED
NTERLUCK YES NO NTERLOCK YES NO 'YES NO ❑
17 5 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE ICLASS
19 ❑ VIN# 39
LICENSE
PLATE# rnr
20 ❑ TRAILER TRAILER ❑ 40
PLATE# STATE PLATE# STATE
21 ❑ [441
TRLR TRLR
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
LecALLv
STANDING S 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ROBIN SMITH 01-01-26 10:40 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26F7 OI BADGE 12986 O#I WA0171300 TIBEAU 1/3/2026 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. EG65340 CASE# ' 26-25 DATE AND TIME 01/01/26 21:25
OF COLLISION
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PAGE 5 OF 5