HomeMy WebLinkAbout26-3254 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-3254 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
Ct ELISION' 04 - 1-- 2026 0426 17 ❑.❑ S 8 W e IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108 AVE SE BLOCK NO. e✓ 19000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 190TH PL
❑ �
0 1 29
UNIT 01 MOTOR CYCLE
❑ YES ]NO
MET PHONE 0 1 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8 DRIVERS. STATE SEX.U D.O.B. 1 1 2 32
❑ :LICENSE# MMDDYY -❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE CNZ0297 STATE WA VIN# 2B3CJ4DGXBH576316
10 9❑ pr ATE#
11[-j7TRAILER STALE PLATE
STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR $ 1 33
vIN#
12 0 0 ' VIN#
FROM TO
VEH.YEAR 2011 DODG CHALLE SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 1 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN UNKNOWN VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VENICLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 vEHICLE ❑ CYCLE ❑ ❑ PROPSOWNE YES No D:2065381431
16 a
LAST NAME VAN FIRST NAME H/EU MIDDLE ID
INITIAL
17 STREET NEW ADOREs7 22239 98TH PL S CITY KENT ST WA ZIP 98031 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.O.B. 02 _ 10 _ 1977 El
39
LICENSE# MMDDYY
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 3 USE 9 1
CLASS ❑
❑ILICENSE 21❑ PLA E# RS11395 TATE 41
WA vIN1 1GAWGPFF3F1254792 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE CHEV MODEL EXPRESS STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HIEUVAN2223998THPLS KENTWA98031 D:2065381431 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 204-9693-F28-47EIN 1 9TOP
VE"LE ❑ N`L J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 $ '
=TAMAIVENA
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12812 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99243
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3254
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) NGO WA
ADDRESS&PHONE#
11207 SE 235TH PL KENT WA 98031 2065381431 SEX M MMDOYyry 08 - 29 - 1969
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE of INJURIES
❑✓ ❑ 2 POS. 3 9 9 9 USE 9 CLASS !0
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O E4
SEX MMDDYYYT
PASSENGER [:]WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
S/TIVENI TAMAIVENA 04-27-26 09:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 5/2/2026 3:52:12 AM
BADGE OR ID# 12812 OR]# ! WA0171300 TIME POLICE DISPATCHED; 4:27 AM TIME POLICE ARRIVED',4:32 AM
PART I PAGE IT]OF 4]
REPORT NO. EG99243 CASE# 26-3254 OF COLLISION
04/27/26 04:26
OF CbLLI510N
NARRATIVE
During this incident, I was equipped with a body-worn camera. It is important to note that the camera
may have captured things I did not perceive, and I may have perceived things not captured by the
camera. This report is intended as a summary of events to the best of my recollection and perception
of what occurred. 1 have paraphrased conversation(s) and may not include an exact sequencing of
events. Any inaccuracies, omissions, or mistakes are inadvertent.
26-3254
On 04-27-2026, at 0426 hours, I was dispatched to an accident with injury located at Bronson Way N
and Sunset Blvd N, within the City of Renton, King County, State of Washington.
Unit 1 had left the scene. The vehicle was identified as a 2011 Dodge Challenger bearing license
plate WA/CNZ0297. The registered owner of the Challenger is Martinez-Medina, Francisco (DOB 9-
18-1996). The driver was not identified.
Unit 2 is Van, Hieu D (DOB 02-10-1977), confirmed by his WA Doi photo. Hieu is the driver of the
2015 Chevy Express bearing license plate WA/RS11395. Unit 2 was occupied with Ngo, Wa (DOB 08
-29-1969), confirmed by his WA Doi photo. WA was sitting in the passenger seat.
Hieu stated that he was driving northbound on 108th Ave S in lane 2. He stated that all of a sudden,
he was struck on the rear of the Express. He believes the driver of the Challenger was driving at a
high rate of speed.
Wa stated that when he was struck, he immediately exited the vehicle and approached Unit 1. He
advised that the driver and the passenger were Hispanic males. Wa was able to photograph the
vehicle and its license plate before Unit 1 U-turned and left the scene, heading southbound on 108th.
Hieu complained of pain in his back and neck. Wa did not have any complaint of injury.
Wa can identify the driver of the Challenger.
There was minimal damage to the Express. The Challenger does have heavy front damage.
If the driver of the Challenger is identified, there is probable cause for hit and run (attended).
Hieu wants to pursue charges.
Photos of the Challenger were uploaded to this case file.
This concludes my report.
My Axon camera was on for this call.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812,
April 27th, 2026, at 0930 hours, Renton, WA.
PAGE 3 OF 4
REPORT NO. EG99243 CASE# 26-3254 DATE AND TIME 04/27/26 04:26
OF COLLISION
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