HomeMy WebLinkAbout26-4132 TFFiNouCERA II I III 1 III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-4132 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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#
CtLLISION' 05 - 1-- 2026 1844 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LAKE WASHINGTON BLVD
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e N SOUTHPORT DR
0 4 29
UNIT 01 VEHICLE
MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 0 8 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8 DRIVERS. STATE : SEX.U D.Q.B. 1 1 2 32
❑ :LICENSE# MMDDYY —❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
rRLR. TRLR. 1 3 33
12 0 0 vIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VENICLE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:9725424664
16 a
LAST NAME COHEN FIRST NAME HAIM MIDDLE
INITIAL
17❑ NEW STREETRE57 ADRESS IS IN ISREAL CITY ISREAL ST ZIP 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO
19 LDI IVE # STATE I SEX M Mr D.C.B. 03 _ 16 _ 1960 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLATE# CVW7948 TATE WA vIN# 3GKALUEG3TL461634 `1
42
22 [TRAILER T
❑ PLATE# STATE PLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2026 MAKE GMC MODEL TERRAIN STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV!TN
44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CORP PV HOLDINGS 15820 TUKWILA INTERNATIONAL TUKWILAWA98188 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VE."Le ES[Z N CITATION# CHARGE
25 i o BOTTOM
LEGALLY Y (�
❑ s a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
NAME
1 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH12986
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4132
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
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.
BRYAN GROZAV 05-29-26 02:13 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
K.LANE 10008 6/17/2026 12:19:48 PM
BADGE OR ID# ( 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED! 7:04 Pry TIME POLICE ARRIVED',7:07 Pry
PART I PAGE IT]OF 4�
REPORT NO. EH12986 CASE# 26-4132 OF COLLISION
05/28/26 18:44
OF CbLLI510N
NARRATIVE
CASE 26-4132
This incident was captured on my body worn video camera and/or in-car dash camera due to the
sensitive circumstances. This report is a summary of events that occurred and is not an exact
sequencing of events.
On Thursday May 28th, 2026, at approximately 19:04, 1 responded to a 911 call regarding a minor hit
and collision at Lake Washington Blvd North and North Southport Dr within the City of Renton, King
County, Washington.
*** CALL REMARKS: 5 AGO, HIT AND RUN TO VEH, NI/BLOCKING.... SUSP VEH WHI SUV
@302780.TX/ GOA EAST ON SOUTHPORT W/DMG TO FRONT END...
I arrived on scene and contacted the driver of unit two, Haim Cohen (DOB: 3.16.1960) who reported
the following; he was stopped at the red light at Lake Washinton Blvd North and North Southport Dr
when he was hit from behind. The vehicle he described as newer white SUV fled the scene east on
North Southport Dr after the collision. Haim was not injured and his vehicle sustained minor damage
to the rear bumper and tailgate. Haim indicated the vehicle was a rental since her was visiting from
Isreal and was on a business trip.
A witness on scene provided the license plate to the suspect vehicle, Texas license plate 302780 but
the DOL did not match the description provided on scene. Haim indicated the suspect driver was a
younger white female.
I provided Haim with a business card with the case number.
This concludes my involvement in this case.
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 B. Grozav #12489 on 5.27.2026 at 23:24 hours in Renton, WA.
PAGE 3 OF 4
REPORTNO.! EH12986 CASE# 26-4132 DATE AND TIME 05/28/2618:44
OF COLLISION
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PAGE 4 OF 4