HomeMy WebLinkAbout26-4196 TFFiNouCERA II I III 1 III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 2s-41ss 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 05 - 1-- 2026 1228 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e BREMERTON AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:3606239435 0 11
30
6� LAST NAME BRANNON FIRSTNAME WHITNEY MIDDLE L 1 1 2 31
INITIAL
STREET ❑1 212 PENNSYLVANIA AVE N CITY EAT0NV/LLE ST I WA 2jp, 983288009 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/INTERLOCK YES[:]NO INTERLOCKYEs Z/NO YES �No /
LRIIVER # STATE WA SEX'F MM D Y' 05
8❑ - 17 - 1990 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aTES� CHP9412 sTArI WAurN# 1GYEK63N62R143831
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2002 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 CADI ESCALA TR DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO ANDREWHOFFMAN 212 PENNSYLVANIA AVE N EATONVILLE WA 98328 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# � 9TOP 5
VE"'CLE CHARGE 10 BOTTOM 36
LEGALLY YES❑NO❑ CITATION# 6A0002184,6A0002184 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES,/ NO D:2066839223
VEHICLE CYCLE OWNER 16 a
LAST NAME PERSHINA FIRST NAME TATYANA MIDDLE
INITIAL
17 STREET❑ NEW ADORE— 264 DAYTON AVE SE CITY RENTON ST WA ZIP 98056 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVE STATE WA ]SEX IF M .C... 05 _ 21 1977 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CLF5162 TArE 41
WA VIN# 1N4CL21E99C190568 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2009 MAKE NISS MODEL ALTIMA STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO,� YES NO
REGISTERED OWNER INFO ALEXANDER PERSHIN 264 DAYTON AVE SE RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 954001972IN 9TOP 5
VEHICLE ❑ CE] CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N
' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH10340
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4196
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 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'
RTF
On 05-31-2026 at about 1317 hours, I was sent to a collision which occurred at the intersection of NE
4th St and Bremerton Ave NE, within the City of Renton, King County, Washington.
Upon arrival nobody was hurt and both drivers were identified via their WADL. They had the same
account of the collision.
Unit 1 made a left turn from the intersection of Bremerton Ave NE onto NE 4th St. The driver was
trying to get into the double left hand turn lane on NE 4th St. Unit 2 was traveling in eastbound lane 2
of NE 4th St and unit 1 collided with unit 2. Unit 2 did not have a stop or yield sign. Unit 1 had a stop
sign.
Driver of unit 1 did not have insurance upon request.
Driver of unit 1 did not yield right of way to unit 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 06-08-26 03:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 6/9/2026 3:36:29 PM
BADGE OR ID# 10065 OR]#' WA0171300 TIME POLICE DISPATCHED! 4:97 Pry TIME POLICE ARRIVED 1:25 PM
PART I PAGE IT]OF 3�
REPORT NO.! EH 10340 CASE# 26-4196 DATE AND TIME 05/31/26 12:28
OF COLLISION
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