HomeMy WebLinkAbout26-3987 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-3987 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 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#
cawsloN 05 - 1-- 2026 1026 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 4TH ST BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e PELLYAVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:8609848378 0 11
30
6� LAST NAME TA FIRSTNAME QUANG MIDDLE N 1 2 31
INITIAL
STREET ❑ 15 MOHEGAN AVE CITY NEW LONDON ST CT ZIP 063208100 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERCENS # STATE CT SEX'M MMDD� 10 - 17 1- 2002 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLA gy 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 FL20760 STATE ID VN# 5NMJBCDE2TH669235
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR 2026 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 HYUN TUCSO UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO Ell HOLDINGS LLC 600 E WATERTOWER STSTEFMERIDIAN ID 83642 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO USAA 060623079U 4
IN EFFECT &POLICY# 9TOP
VE—L' CHARGE 1 5 36
15❑ LEGALLv STANDING YES❑NO❑ CITATION# 1 o BOTTOM
8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2069105055
LAST NAME PREBOSKI FIRST NAME JESSICA MIDDLE C
INITIAL
17❑ STREET NEW ADDRESS❑' 7824 S 113TH ST CITY SEATTLE ST WA ZIP 981783238 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 LICENSE# STATE WA SEX F M D.C.B. 02 _ 11 1988 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CSX1774 TATE 41
WA VIN# WBY33HD07SFU65466 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2025 MAKE BMW MODEL 14 STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JESSICA PREBOSK17824 S 113TH ST SEATTLE WA 98178 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE 8 POLICY#E CO SAFECO H2331061IN 0( STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGALLY YES N
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MATTHEW TRAINO 12811 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EHO5600
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3987
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DOAN MINH T
(LAST FIRST,
ADDRESS&PHONE#
118 S!ILLY ST APT 1 MOSCOW/D 838432092 2084881798 SEXi F MSEAT MDOYyry 01 - 15 - 1989
PASSENGER Z WITNESS❑ UNIT# 1 PC USE 2 CLASS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEXt 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.
MATTHEW TRAINO 05-23-26 11:49 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
PHILIP DAVIS 12018 5/24/2026 3:48:12 PM
BADGE OR ID# 1Y899 ORI#' WA0171300 TIME POLICE DISPATCHED 40:27 AM TIME POLICE ARRIVED 10:29 AM
PART I PAGE IT]OF 4�
REPORT NO. EH05600 CASE# 26-3987 OF COLLISION
05/23/26 10:26
OF CbLLI510N
NARRATIVE
On 05/23/2026 at approximately 1027 hours, while employed as a uniformed Patrol Officer for the
City of Renton, I was dispatched to a Blocking Accident at the intersection of N 4th ST and Pelly Ave
N, within the City of Renton, County of King, State of Washington.
Unit# 1 was driving northbound on Pelly Ave N and was struck by Unit# 2 which was heading
westbound on N 4th ST.
Upon arrival I contacted the driver of U-1, identified by his CTDOL as Quang N. Ta (10/17/2002). Ta
stated that he had stopped for a stop sign on Pelly Ave N, looked both ways, then began driving
northbound across N 4th ST when he was struck from the right by U-2. Ta stated that he did not see
U-2 approaching. Ta had a passenger identified as Minh T. Doan (01/15/1989). Neither Ta nor Doan
reported any injuries.
I contacted the driver of U-2, identified by her WADOL as Jessica C. Preboski (02/11/1988). There
are four lanes of westbound traffic on N 4th ST, Preboski said that she was driving in the #3 lane
when U-1 pulled in front of her. She said that she attempted to brake but was unable to avoid colliding
with U-1. Preboski did not report any injuries.
U-1 sustained moderate damage and was towed from the scene. U-2 sustained minor damage.
Based on the totality of the circumstances, I determined that the proximate cause of the collision was
Ta's failure to yield to oncoming traffic before proceeding through the marked stop sign. I used my
discretion and did not issue Ta a notice of infraction.
N/F.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Ofc. M.Traino #12811 05/23/2026 / 1149 hours-Renton, WA
PAGE 3 OF 4
REPORT NO. EH05600 CASE# ' 26-3987 DATE AND TIME 05/23/26 10:26
OF COLLISION
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PAGE 4 OF 4