HomeMy WebLinkAbout25-81135 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG65740OLCERA
COLLISION REPORT 1591971
CASE# 25-81135 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOO`CODIGENC'Y 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
3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
ear soe' 12 - 29 - 2025 1902 17 =.= S 8 W e IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
FIELD AV NE BLOCK NO. e 1600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 200 00-] MILES N FEET e✓ S 8✓ E e FIELD PL NE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4253511114 1 4 30
6 LAST NAME BALBINO FIRST NAME REGINA MIDDLE C 1 2 31
INITIAL
STREET ❑ 5210 NE 16TH ST CITY; RENTON ST WA ZIP 98056 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs ND✓ (NTERLOCKVEs Nb✓ YES NO✓
$ DCIENSE# STATE SEX I U MMD4YY' 07 - 25 - 1972 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 2
USE :CLASS HEAD NECK
LICENSE, CFD3058 STATE WA VIN# 3MYDLBYV4KY507806 3
10 F1 as ATP tt
TRAILER
11 2 5 STATE TRAILER STATE PLATE# PLATE# ROM To
TRLR zRLR 1 1 5 33
12 0 0 VIN#' VIN#
FROM TO
HICLE
13 4 VEH.YEAR 2019 MAKE TOYT MODEL YARIS STYLE VEHICLE TO YED NOIyS46LIN diW9YMEYER GESr`-IVT ENp✓ m 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO MARCIO SANT0552f0 NE 16TH ST RENTON WA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE[%/] INSU&POLIRANCECY# CO ALLSTATE 942301909 3 4
IN EFFECT 9TOP
vEn ' CHARGE t 5
LecALLr yes❑NO❑ CITATION# 36
t a 80TTOM
15❑ STANDING s 7 e
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 VEHiC1.E CYCLE nWNFR YES�/ NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY, RENTON ST ZIP ❑ 37
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 38
CDL INTERLOCKYES NO✓ INTERLOCK YESEl
ND✓ YEs NO✓
19[ DRIVER'S
# STATE SEX U M.00B. —� � 39
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 USE 9 CLASS 0 ❑
21 LICENSLATE E BON0220 raTE WA vIN# USE
41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 200$ MAKE TOYT MODEL COROLL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO✓
REGISTERED OWNER INFO EDWARD KANG 17059166TH PL SE RENTON WA 98058 D:4255914163 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE[Z INSURANCE CO AMICA 96034626HC
IN EFFECT &POLICY# t STOP
1— ❑ ,.I—I CITATION11 CHARGE to BOTTOM
LEGALLY YES N
25 s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG65740
COLLISION REPORT III III III III III 111
1591972 CASE# 25-81135
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE 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
Unit 1 traveling south along 1600 block Field Av NE. Unit 2 parked legally along side of roadway.
Unit 1 driver reported swerving to avoid animal darting in roadway, causing Unit 1 driver to veer and
crash into Unit 2. Unit 1 sustains reportable disabling front passenger damage. Unit 2 sustains
reportable disabling rear driver damage. Unit 1 driver later transported to hospital for further possible
head and neck injuries. No evidence of HBD or impairment of Unit 1 driver.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-29-25 09:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 1/5/2026 1:08:45 AM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:04 PM TIME POLICE ARRIVED i 7:06 PM
(PART B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG65740 CASE# 25-81135 DATE AND TIME 12/29/2519:02
OF COLLISION
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