HomeMy WebLinkAbout26-3539 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-3539 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 05 - 1-- 2026 1551 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 2725
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066362268 0 11
30
6� LAST NAME KONDRATOV FIRSTNAME STANISLAV MIDDLE 1 2 31
INITIAL
STREET ❑ 9624 FRONTIER AVE SE UNIT J40 CITY SNOQUALMIE ST I WA 2jp, 980655312 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� LEM637N sTArI WAvIN# WA1A4AFYOJ2135586
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 1 34
13 A 2018 AUDI SQ5 DAMAGE vEs 0NO agW�MEYERS ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
A LIABILITY INSURANCE INSURANCE CO 2 3 4
14 ❑ STANDARD FIRE INSURANCE CO 6112491122031
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEcnLLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069530122
16 a
LAST NAME SE SE FIRST NAME JOHN MIDDLE I E
INITIAL
17❑ STREET ❑', 13731 25TH AVE SE CITY MILL CREEK ST WA ZIP 980124624 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA SEX M D.C... 09 _ 05 _ 1991 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CFU8933 TAre WA VIN# 7SAYGDEEOPF604009
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
V I
VEH YEAR 2023 MAKE TESL MODEL MODE!Y STYLE DEHICLE AMAGE TOWED✓ TOO BLIN TOWED B Gov HPRIVATE YES NO�/ 44
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4352735-F26-47BIN IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EHO5309
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3539
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BARBIN SERGEYA
(LAST FIRST,
ADDRESS&PHONE#
7969 LYNNWOOD DR FERNDALE WA 98248 3606030685 SEX M MMDOYyry 07 - 13 - 1998
PASSENGER I�I WITNESS�'UNIT# 1 POS 3 AIRBAG 2 RESTR. 4 EJECT ? I HELMET INJURY NAruRE of INJURIEs
L�!1 USE .CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
C.ARNOLD 05-07-26 04:41 PM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 5/22/2026 11:01:57 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED; 3:58 PM TIME POLICE ARRIVED',4:09 pry]
PART I PAGE IT]OF 4�
REPORT NO. EH05309 CASE# 26-3539 OF COLLISION
05/07/26 15:51
OF CbLLI510N
NARRATIVE
CC 26-3539
On 5/7/2026 at 1558 hours I was dispatched to a motor vehicle collision at the parking lot of Safeway
located at 2725 NE Sunset Blvd in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was parked within a parking stall and was preparing to drive forward (North)
from the parking spot to leave the parking lot.
Driver 1 stated that he was proceeding North within the parking lot just South of Unit 2.
Collision
Driver 2 stated that he pulled forward and upon doing so, Unit 1 approached from the South and the
front drivers side bumper of Unit 1 collided with the front passenger side wheel/bumper of Unit 2.
Driver 1 stated that Unit 2 pulled out of the parking space in front of him and he was unable to stop or
slow to avoid a collision. Driver 1 stated that the front drivers side bumper of Unit 1 collided with the
front passenger side wheel/bumper of Unit 2.
Injuries
None reported.
Vehicle Disposition
Unit 1 was towed from the scene by Gene Meyers and Unit 2 was towed by a private tow.
Proximate Cause
I am unable to determine the proximate cause of this collision as it occurred on private property. This
report is for insurance purposes only.
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 C. Arnold #12509 at 16:37 on 5/7/2026 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EH05309 CASE# ' 26-3539 DATE AND TIME 05/07/26 15:51
OF COLLISION
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PAGE 4 OF 4