HomeMy WebLinkAbout26-4100 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 26-4100 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4340 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 05 - 1-- 2026 1319 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
101 SW GRADY WAY BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066503583 0 11
30
6❑ LAST NAME EBRAT MENDEZ FIRST NAME YUZAMED MIDDLE Z 1 1 2 31
INITIAL
STREET ❑ 8558 NESBIT AVE N 114 CITY SEATTLE ST WA 2jp, 98103 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX' ID
M MD-O B 06 1- 17 - 1983 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CUV4633 sTArI WAurN# JTDKN3DU7D5690525
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 A 2013 TOYT PRIUS SD DAMAGE vEsNo �LII� RS TOW vEs❑ No
REGISTEREDOWNERINFO YUZ4MEDEBRATMENDEZ8558NESBITAVEN114SEATTLEWA98103 D:2066503583 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VENICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2065664782
16 a
LAST NAME ASGADOM FIRST NAME HABTOM MIDDLE H
INITIAL
17❑ STREET ❑', 122 CHICAGO BLVD S CITY' PACIFIC ST WA ZIP 98047 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK vEs I I NOF YEs t l NO❑
19[—] LDI IVEW # STATE WA SEX M M D.C.B. 11 25 _ 1985 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CJD2521 TAre WA VIN# 5YFEPRAE1LP142416
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2020 MAKE 7'Dy7- MODEL CORO!! STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED By ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 4675822-DO9-47CIN 1U�VE"LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SlTIVEN/TAMAIVENA 12812 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH06630
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4100
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TRAVNIKAR MAREK V
(LAST FIRST,
ADDRESS&PHONE# D.0.B.
608 BLUE HILLS DR DRIPPING SPRINGS TX 78620 5124264824 SEX M MMDDYYYY 10 - 31 - 1996
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D 0 E4
MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.0.8.
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.
SITIVENI TAMAIVENA 05-27-26 10:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
NfCOLAS SANGDER 11350 512812026 1:29:16 AM
BADGE OR ID# 12812 OR]# ! WA0171300 TIME POLICE DISPATCHED 1:20 Pry] TIME POLICE ARRIVED:1:24 PM
PART I PAGE IT]OF 6�
REPORT NO. EH06630 CASE# 26-4100 OF COLLISION
05/27/26 13:19
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. I have paraphrased conversation(s) and may not include an exact sequencing of
events. Any inaccuracies, omissions, or mistakes are inadvertent.
26-4100
On 05-27-2026, at 1319 hours, I was dispatched to an accident located at SW 101 SW Grady Way,
within the City of Renton, King County, State of Washington.
Dispatch advised that the reporting party was reporting a 3-vehicle accident.
I arrived on the scene and observed 3 vehicles blocking 3 lanes, 1 going eastbound on SW Grady
Way.
The vehicles and subjects were run using the police database.
Unit 1 is Ebrat Mendez, Yuzamed Z (DOB 06-17-1983), who was driving a 2013 Toyota Prius bearing
license plate WA/CUV4633.
Unit 2 is Asgadom, Habtom H (DOB 11-25-1985), who is the driver and registered owner of the white
2020 Toyota Corolla bearing license plate WA/CJD2521.
Unit 3 is Burns, Michael D (DOB 07-14-1989), who is the driver of the white 2020 Ford F450 bearing
license plate WA/CO259D.
Witness is Travnikar, Marek V (DOB 10-31-1996), who was behind Unit 3 and witnessed the whole
collision.
I spoke with Michael, who stated that he was waiting at a red light in lane 2 when he was struck by
Asgadom and Yuzamed. He stated that the vehicle had struck the right side of his Ford, causing
minimal damage.
I spoke with Habtom, who stated he was traveling in lane 1 eastbound on SW Grady St. He stated
Yuzamad was in the left-turn lane and pulled in front of his vehicle in lane 1, causing a collision and
causing him to strike Unit 3.
Marvek stated that he was behind Unit 3. He stated that he saw Unit 1 on the left turn lane, but facing
westbound. The left-turn lane is only for eastbound traffic. He stopped his vehicle and gave space for
Unit 1. Unit 1 made a U-turn crossing lanes 1, 2, and 3. He stated that he believes Unit 1 did not see
Unit 2 traveling in lane 1. Unit 1 collided with Unit 2, causing them to collide with Unit 3.
Unit 1, Yuzamed stated that he was in the left lane and tried to turn into lane 1. He said cars made a
path for him, which he took, and said that unit 2 was speeding in the lane, which he believes caused
the collision. Yuzamed spoke Spanish. I used my Axon body camera, which has a Spanish translator,
to communicate with Yuzamed.
All subjects were cleared with their DOL, except Unit 1, which is Yuzamed. Yuzamed provided me
with his identification card. Officer Watson ran his ID, which returned suspended and revoked in the
1st degree. Yuzamed was detained in handcuffs.
I read Miranda Warning to Yuzamed, which he stated he understood and wanted to speak with me. I
asked if he was driving the red Prius he said yes. I also asked if he was involved in the accident, and
he stated yes.
Yuzamed was arrested and transported to SCORE jail for driving while his license was suspended in
the 1 st degree.
The Yuzamed Prius was towed because it was blocking lane 1 on SW Grady Way.
Please forward this to the Renton Municipal Prosecutor's office for review.
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,
May 27th, 2026, at 1939 hours, Renton, WA.
PAGE 3 OF 6
REPORT NO. EH06630 CASE# 26-4100 OF COLLISION
05/27/26 13:19
OF CbLLI510N
NARRATIVE
PAGE 4 OF 6
SUPPLEMENTAL REPORT NO. EH06630
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 26-4100
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MCITOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE t_"J CYCLE u PEDESTRIAN � OWNER � YEs NO
D:2062311972
OF 1 29
LAST NAME BURNS FIRST NAME MICHAEL MIDDLE' D
INITIAL
STREET r:i 30
❑ NEW AnnRFSP' 1201 S 336TH ST Q307 CITY FEDERAL WAY ST WA ZIP 98003
6
CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs NO zERLOCK YES[:]NO[:]
vES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 07 - 14 - 1989
7
ON DUTY� STATUS AIRBAG' 2 RESTR. 2 EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE I CO259D [TAT WA VIN# 1FDOX4GNOLEC31049
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLI 'nTV vEHICi F FROM To
2020 FORD F450 TRfNTY METRO
DAMAGE YES�NO YES NO
REGISTERED OWNER INFOMICHAEL BURNS 1201 S 336TH ST Q307 FEDERAL WAY WA 98003 D:2062311972 SHADE IN DAMAGED AREA ] $ 33
12 �
LIABILITY INSURANCE INSURANCE CO KING COUNTY SELF FROM To
34
IN EFFECT &POLICY# 9 TOP
13 ew e 01 CITATION# CHARGE
V 0BO OM
Ecnuv YES NO
STANDING �} 8 7 b
14 ❑ UNIT Tr Vd 1QRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE 36
INITIAL I
❑
STREET
16 NEW AnnR"Fll
CITY ST ZIP
CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YES NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE VIN#
PLATE# rnr
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 a 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P _ 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LeG E
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SITIVENI TAMAIVENA 05-27-26 10:25 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 12812 O#I',WA0171300 SANGDER 5/28/2026 PAGE OF 6
3000-345-013 IR 11t18)
REPORT NO. EH06630 CASE# ' 26-4100 DATE AND TIME 05/27/26 13:19
OF COLLISION
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PAGE 6 OF 6