HomeMy WebLinkAbout26-1482 ("7—
STATECE TRAFFicNREPORT NO. EG84704 1 027
,one COLLISION REP F 1591971
CASE# 26-1482 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 02 - 22 - 2026 1404 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
NE 12TH ST 8✓ .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �, FEET MILESe S e N!8 JEFFERSON AVE NE
0 4 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES NG �/ D:9517308247 0 7 30
6� LAST NAME SAMAYOASAMAYOA FIRST NAME MIGUEL MIDDLE'' A 1 2 31
INITIAL
STREET E:1' 24937 ATWOOD CITY MORENO VALLEY
NEWADDRESs S7 CA ZIP 925530000 z
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
❑
INTERLOCK YES LINOZINTERLOCK YES No W YES NOW
8❑ LDICENS STATE : CA SEX'M MMDDW 04 - 09 - 1990 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE HELMET 2 CLASS
Y 1 NATURE OF INJURIES 2
10 9❑ PI AT�SE EP19894 STATE CA WIN# 1HTMMMML2GH219946 3�
11 2 5 PLATE# STATE TRAILER PLATE# STATE ROMRA
To
rRLR TTRURj 7 1 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR 2016 MAKE INTL MODEL STYLE TR VEHICLE TOWED TO BLIN TOWED BY GO VT.VEHICLE g 9 34
13 DAMAGE YES No ✓ YES❑ 1NO
REGISTERED OWNER INFO RHJ.END TRANSPORT121171/4MAGNOLIASTREETELMONTECA91732 D:6269751043 VEHICLE ED 1 ❑
SHADE 1N DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO CANAL INSURANCE COMPANY CT2110228318.1 4
IN EFFECT &POLICY# 4TOP
V""L' CHARGE i 5 ❑ 36
EGAL,Y YES❑NO CITATION# 6A0002171 INATTENTIVE DRIVING a BOTTOM
MOTOR PEDAL-: PEDESTRIAN PROPERTY 01 DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE OWNFIR YES NO D:2067514331
16�
LAST NAME SIN FIRST NAME JASON MIDDLE
INITIAL
STREET
17❑ NEW ADDREsZ' 1105 N 38TH ST CITY RENTON ST, WA ZIP 980561541 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDI.CALTRANSPORTED � 38
1NTERLOCKvF No INTERLOCkCvEs no Yes NOR
19 F] DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H LMET 2 CLASS 1 NATURE OF INJURIES 40
❑21❑ LICENSE 41
CES1404 TATf'WA YIN# 1G1YM2D76G5106694 1
PLATE#
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2016 MAKE CHEV MODEL CORNETT STYLE CP DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
O
24 YES
REGISTERED OWNER INFO JASON SIN 1105N38TH ST RENTON WA 98056 D:2 0 6 7514 3 3t VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILY BX11060659
IN EFFECT &POLICY# t 4TOP 5
VEHICLE YES J
� N.
LEGALLY 1-1 CITATION# CHARGE tOBOTTQM
25 B
7EHANG
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 10065 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG84704
COLLISION REPORT III III III III III 111
1591972 CASE# 26-1482
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
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 CIASS ----�
: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
On 02-22-2026 at about 1410 hours, I was sent to a collision which occurred at the intersection of NE
12th St and Jefferson Ave NE, with in the City of Renton, King County, Washington.
Upon arrival the drivers were positively identified via a WADL and CADL. Both were clear and valid.
Both drivers had the same account of the collision.
Unit 2 was stopped behind another vehicle which was stopped in the middle of the street. Unit 2 was
partially in the intersection headed westbound on NE 12th St. Unit 1 was headed eastbound on NE
12th St and made a left turn onto Jefferson Ave NE. During the left turn, the rear of unit 1 struck unit
2.
The driver of unit 1 was not paying attention and struck unit 2.
No injuries occurred and both vehicles were able to drive away after the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 02-26-26 06:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 3/11/2026 10:29:46 AM
BADGE OR ID# ! 10065 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:90 Pry/ TIME POLICE ARRIVED i 2:23 PM
PART B 3000-345.160(R1Vt8) PAGE 0 OF F3
REPORT NO. EG84704 CASE# 26-1482 DATE AND TIME 02/22/2614:04
OF COLLISION
t
1t
� L
1
Ih
r 1 j t k
t
t
'Z `4 :`
u
4
tl
t d
yl ;
r Y �4 tY
Y rYaddumm'v&�'v%d f
l4
' r .
�rj tt3X�tl�3r
s,
i
�l
3
1Q�
WS 5.K
e
r r +
PAGE 3 OF 3