HomeMy WebLinkAbout26-3778 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 26-3778 2 576
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4100 3❑HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' FENCE
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 05 - 1-- 2026 2224 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S BLOCK NO. e✓ Y900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S 29TH ST
2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2069453584 0 81
30
6� LAST NAME YAKUBOVYCH FIRSTNAME ANDRII MIDDLE 1 1 31
INITIAL
STREET ❑✓ 1455 PUGET DR S#H303 CITY RENTON ST WA ZIP' 98055 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CUU2597 sTArr WAurN#' WBA3A9G58DNP37968
10 PI ATE i4
--- TRAILER STATE PLAT Eft STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2013 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 9 9 34
13 4 BMW 335 SD DAMAGE YES NO �MEYERS YYES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT I SUR N# 9TOP
VE— CHARGE 36
LEGALLY YEs NO CITATION# 6A0284886 OP MOT VEH W/OUT INSURANCE o aorrom
15❑ STANDING 8 7
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063179377
16 a
LAST NAME MARCELO MARTINEZ FIRST NAME PABLO MIDDLE
INITIAL
17 NEW STREETREs7' 11408 SE 164TH ST CITY RENTON ST WA ZIP 98055 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK Y�EsI I I NOF YEs I� NO❑
19 LICENSE# STATE WA SEX M M D.C.B. 09 _ 20 _ 1993 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 9 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS UNKOWN
❑21❑ PLATE# BXF1141 TArE 41
WA VIN# SFNYF4H91D8059710 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN 43
TIN##. IN RLR
' #.
TOWED eY Gov HI 44
VEH YEAR 2013 MAKE HOND MODEL PILOT EX STYLE $V DAMAGE TO WED✓ NOO BLIN GENEMEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 4851229-BO2-47EIN STOP 5
VE—LE CITATION# CHARGE to BOTTOM
LEGALLY YESZ NEB 6
25❑ OF
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
THOMPSON 13311 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH03661
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3778
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
POS. 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 FIRST 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.
MICHAEL THOMPSON 05-16-26 01:12 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 5/17/2026 10:23:39 PM
BADGE OR ID# ` 13311 ORI#' WA0171300 TIME POLICE DISPATCHED 40:24 PM TIME POLICE ARRIVED',10:34 PM
PART I PAGE IT]OF 4]
REPORT NO. EH03661 CASE# 26-3778 OF COLLISION
05/15/26 22:24
OF CbLLI510N
NARRATIVE
26-3778
On 5-15-2026 at 2234 hours I responded to a blocking collision with injuries at Benson RD S and S
29th ST in the City of Renton, King County, Washington.
Upon my arrival I observed Unit 1 facing south towards Benson RD S with it's rear end against a
residential fence. Unit 2 was facing north on S 29th ST with its front end off the roadway.
Both Units appeared to meet the damage threshold and were towed by Gene Meyers.
Driver 1 was walking around the collision site and did not have any complaints of pain.
Driver 2 was being evaluated for injury by Renton Fire. He was transported to the hospital, Renton
Fire was concerned with his elevated blood pressure.
Driver 1 provided a valid driver's license, and registration. He stated he did not have insurance for
Unit 1. 1 cited
Driver 1 for operating a vehicle without insurance.
Driver 1 stated his vehicle lost control due to traction control not working while driving around a
corner northbound on Benson RD S. He stated his vehicle spun several times before colliding with
Unit 2.
Driver 2 was stopped on S 29th ST at the intersection of Benson RD S when Unit 1 collided with his
vehicle. I was unable to speak with Driver 2 due to him being transported to the hospital.
Based on my observations at the scene of the collision, and Driver statements I determined the
proximate cause of this accident to be Driver 1 losing control of his vehicle and colliding with Unit 2.
1 provided a copy of the exchange of information to both drivers via email.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer Michael A. Thompson #13311 at 2328 on 5/15/2026 in the City of
Renton, King County, Washington.
PAGE 3 OF 4
REPORT NO. EH03661 CASE# 26-3778 DATE AND TIME 05/15/26 22:24
OF COLLISION
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