HomeMy WebLinkAbout26-959 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG74340OLCERA
COLLISION REPORT 1591971
❑ 0✓ RESULTED I
CASE 26-959 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 28
TRIBAL i UNITS 01 STRUCK TREE OR STUMP
RESERVATION I 1 1 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 02 - 02 - 2026 1754 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
SW7THST MILE POST
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ C------ 1.1 FEET e S 8 W e LIND AVE SW
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2538826843 30
5 LAST NAME ARTEAGA FIRST NAME RAFAEL MIDDLE T 1 1 2 31
INITIAL
STREET '❑ 16212121STAVESE CITY; RENTON ST WA ZIP, 98058 2�
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No�/ INTERLOCKYEs No�/ YES No�/
8 DCIENSE# STATE WA SEXI M MMDDYY' 02 - 03 - 1994 32
9� ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES 2
USE ,CLASS RIGHT EAR PAIN
10 LI ENSE BYU0302 STATE WA VIN#, WPOCA29813U622764 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# 7 ROM
TRLR TRLR 3 7 33
12 VIN#' VIN#
: FROM TO
HICLE
13 4 VEH.YEAR 2003 MAKE FORS MODEL BOXSTE STYLE SD VEHICLE TO YED NO fiS46LIN diW9YMEYER YESE IGOVT ENp m 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO RAFAEL ARTEAGA 16212 121STAVE SE RENTON WA 98058 D:2538826843 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE / INSURANCE CO ALLIANT INSURANCE ADMO823921 < 34IN
EFFECT &POLICY#VEn" CHARGE 36
Lec LY YES❑NO❑ CITATION# t15 STM ING
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT�' PEDESTRIAN
VEHICLE CYCLE' DOWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY ST ZIP 4❑ 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED 38
INTERLOCKYEs No INTERLOCK YES R No YEs NQ
19 LICENS# STATE SEX MMDDYY —= 39
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASS ❑
21 PLATE# rare vIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
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
1-1— ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGnLLY YES NC
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG74340
COLLISION REPORT III III III III III 111
1591972 CASE# 26-959
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) BAGHERI ARTIN
ADDRESS&PHONE# D�
1807 S 118TH ST APT 407 SEA TTLE WA 98168 2064502976 SEXi M MMDD.O B. 12 — 28 — 2002
PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ 1 POS. 3 6 4 1 USE 2 '.CLASS 1 � ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL}
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
I was dispatched to a vehicle collision on 02/02/26 at the intersection of SW 7th St and Lind Ave SW,
in city Renton, King County WA.
Unit 1 BYU0302 Driver: Rafael T. Arteaga (DOB 02/03/1994)
Upon arriving I saw a vehicle in a tree with two subjects outside the vehicle. I spoke to the driver who
told me that he was traveling West on SW 7th St. When he took off through the intersection of SW 7th
St and Lind Ave SW, he went to shift into 2nd gear he lost control due to the puddle of water and hit
the tree. He complained of Right ear pain and believed he blew his ear drum. The passenger stated
that his right leg hurt but other than that he was fine.
I gave both parties involved a case number as a reference.
Renton Fire responded to scene due to air bag and evaluated both parties.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 02/02/2026, 2152 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 02-02-26 10:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
2/3/2026 12:30:30 AM
STEVEN FAJARILLO 12847
BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:56 PM TIME POLICE ARRIVED i 6:02 PM
PAST B 3 Da-lmx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG74340 CASE# 26-959 DATE AND TIME 02/02/2617:54
OF COLLISION
`t.
i}u
3
µq �1
1itJ
a' M
k#
u
4
l
t�
t
,t x
F
a
t
a
PAGE 3 OF 3