HomeMy WebLinkAbout26-2297 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 26-2297 z 0 7
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF; M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 03 - 1-- 2026 0730 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 2100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 10 00 FEET MILES e S B W e S 21ST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3464757846 0 81
30
6 LAST NAME I MEXQUITIC REBOLLOSO FIRST NAME RODRIGO MIDDLE 1 1 1 2 31
INITIAL
STREET ❑, 23225 109TH PL SE CITY KENT ST I WA 7jp, 980313473 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ DRIVERS
E# STATE WA SEXI M MM DAY' 06 1— 20 — 2005 2 32
LICEN —' [NATURE OF INJURIES
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 . EJECT 1 HELMETU E 2 CLASS'NJURY7 I COMPLAINT OF HEAD PAIN 2❑
3
LICENSE CKY5900 sTArr WA urN If JH4DC53806S008666
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2006 ACUR RSX 2H MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9
✓ 34
13 4 DAMAGE YES NO YESYES[:] NO
REGISTERED OWNER INFO TAMARA 14ERNANDE-7 ALAS 23225109TH PL SE KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 864112396 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 6AO092322 FOLLOW VEHICLE TOO CLOSELY <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ PROPSOWNE ❑ YES NO ,/ D:2068528627
16 a
LAST NAME DAVIS 77771 FIRST NAME SINA MIDDLE N
INITIAL
17❑ STREET ❑', 30645 122ND AVE SE CITY AUBURN ST WA ZIP 980923379 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 D IVEW # STATE WA SEX DDY
F M .C... 10 � 1981_ 09 _ 39
CENS —NATURE OF INJURIES
H USE ET NJAURSY COMPLAINT OF LEFT KNEE PAIN 40
20 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 2 7
21❑ LICENSE I CWB8218 TAre WA VIN It 2T2BAMCA9SC115508
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2025 MAKE LEXS MODEL RX STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO DAVIL DAVIS 30645122ND AVE SEAUBURNWA98092 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4687855 E0647DIN 1 9TO'
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG96901
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2297
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
PM 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.
D.NELSON 03-27-26 06:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 4/23/2026 11:29:39 AM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 7:36 AM TIME POLICE ARRIVED',7:43 AM
PART I PAGE IT]OF 4�
REPORT NO. EG96901 CASE# 26_2297 O COLLOTINIE
OFF CbLLI510N 03/24/26 07:30
NARRATIVE
26-2297 ACCINJ
On 3/24/2026 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a blocking collision in the 2100 block of Benson Dr S
Renton/King/WA. The caller was reporting that two vehicles were blocking Benson Dr S.
I arrived on scene and located both vehicles pulled off the roadway. I asked both drivers about injury,
the driver of Unit 1 advised he had head pain and the driver of Unit 2 advised she had knee pain. I
called RRFA the scene for an evaluation.
The driver of the 2006 Acura RSX WA/CKY5900 (Unit 1) was identified by his WADL as Rodrigo I
Mexquitic Rebolloso DOB: 6/20/2005. Rodrigo said that he was driving north on Benson Dr S in the
#2 lane, he said that he was approaching the green stop light when Unit 2 stopped before entering
the intersection. He said that he collided with the rear bumper of Unit 2. There was damage to the
front hood and bumper of Unit 1, but it was drivable. Rodrigo advised he hit his head on the steering
wheel during the collision, RRFA responded to the scene, evaluated, and cleared Rodrigo.
The driver of the 2025 Lexus RX WA/CWB8218 (Unit 2) was identified by her WADL as Sina Davis
DOB: 10/9/1981. Sina said that she was driving north on Benson Dr S in the #2 lane, she said that the
light was green, but traffic was heavy and there were two vehicles blocking the intersection. She said
that she slowed to a stop before entering the intersection. As she was stopped waiting for traffic to
clear the intersection, she was struck by Unit 1. There was minor damage to the rear bumper of Unit
2, it was drivable. Sina advised she had slight paint to her left knee, RRFA evaluated her and cleared
her at the scene.
Both drivers returned clear and valid WACIC/NCIC/DOL.
I cited Rodrigo for Following Vehicle Too Closely RCW 46.61.145.1 under Sector citation
#6A0092322. This citation should be mailed to his DOL address.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 3/24/2026 Renton WA
PAGE 3 OF 4
REPORT NO. EG96901 CASE# 26-2297 DATE AND TIME 03/24/26 07:30
OF COLLISION
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PAGE 4 OF 4