HomeMy WebLinkAbout26-3387 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EH07261 170
27
COLLISION REP FIT 1591971
CASE 26-3387 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
COLLISION' 05 - 1-- 2026 1117 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 2ND ST BLOCK NO. e✓ 2700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ W e GLENNWOOD PL NE
1 2 29
R PEDAL- DAMAGE
MOTO THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
No ,/ I D:2065617149 0 11
30
6� LAST NAME XU FIRSTNAME SHAN MIDDLE 1 2 31
INITIAL
STREET ❑, 4262 133RD AVE SE CITY BELLEVUE ST WA ZIP' 98006 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10� P1 aT�S� BAt3581 sTArI WAVIN# WBA3C1C54DF438456
----� TRAILER STATE PLA Eft STATE
11 0 0 PLATE# PLATT E# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 D OW BMW 328 SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFOS.IXU4212131RDAVESEBELLEVUEWA98006 D:2065617149 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCE COAMERICAN FAMILY WSA3C1C54DF438456 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e 5 36
LEGALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4257576056
16 a
LAST NAME MENDOZA JIMENEZ FIRST NAME JOSEFINA MIDDLE
INITIAL
17❑ STREET ❑', 12728 SE 163RD ST CITY' RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19[ D IVERI #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 USE CLASS 1 ❑
41
21❑ LICENSE CVW8183 TAre WA VIN1i KMHDH4AE46U093303
❑
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2011 MAKE HYUN MODEL ELANTRA STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOB HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JOSEFINA MENDOZA JIMENEZ 12728 SE 163RD ST RENTONWA 98058 D:4257576056 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 866712202IN I STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH07261
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3387
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM 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 FIR57 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.
KEITH PETTY 05-03-26 02:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 5/30/2026 4:38:53 PM
BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED 11:23 AM TIME POLICE ARRIVED',11:32 AM
PART I PAGE IT]OF 4�
REPORT NO. EH07261 CASE# 26-3387 OF COLLISION
05/02/26 11:17
OF CbLLI510N
NARRATIVE
26-3387
On 05/02/2026 at approximately 1123 hours, I was dispatched 2720 NE 2nd ST in the City of Renton,
County of King, State of Washington for an accident with no injuries.
Unit 1 was a white 2013 BMW 328 (BAL3581/WA) VIN/WBA3C1C54DF438456, driven by Shan Xu
(DOB 12-01-1986) Mandrin speaking only.
Unit 2 was a red 2011 Hyundai Elantra (CVW8183/WA) VIN/KMHDH4AE4BU093303 driven by
Jimenez Josefina Mendoza (DOB 1 1 01 6-1 983). Spanish speaking only. Both parties were identified
by their WADL's.
Unit 1 described through language line that she was attempting to enter the roadway and did not see
unit 2. Unit 1 collided into the side of unit 2 causing over $1000 in damage.
Unit 2 stated she was driving past unit 1 and as she went by unit 1 pulled out and collided into the
side of her vehicle.
The collision seemed minor, but the right front tire was unable to rotate. The damage was significant
enough the vehicle had to be towed.
I provided an exchange of information for both parties.
This incident was captured on my body-worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 05/03/26t 1420 hours, Place: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EH07261 CASE# ' 26-3387 DATE AND TIME 05/02/26 11:17
OF COLLISION
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