HomeMy WebLinkAbout26-4249 STATE OF II I III 1 IIIllI111IN II II I REPORT NO. EH13024 170
27
COLLISION REP FIT 1591971
SASE 26-4249 2
INTERSTATE ❑ CITY STREET FIRE ❑
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 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 06 - 1-- 2026 1007 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e OLYMPIA AVE NE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2062619173 0 11
30
LAST NAME VILORIA CHINCHILLA FIRST NAME MAXIMO MIDDLE q
6 INITIAL 1 2 31
STREET ❑ 500 MONROE AVE NE APT E2 CITY RENTON ST WA ZIP 980563954 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CTE4770 sTArI WAvIN# KNDJT2A62C7480886
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2012 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 KIA SOUL SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO ..0 VILORIA CHINCHILLA 3811 NE 3RD CT APT 1115 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE Z INSURANCE CO NATIONAL GENERAL 2034833229
IN EFFECT &POLICY# GE1013
9TOP
EwcLE V CHAR 5 36
ALLY YES❑NO CITATION# 6AO092350 FLD SIGNAL STOPS/TURNS-UNSAFE o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2537669248
16 a VEHICLE CYCLE OWNER
LAST NAME JARVIS FIRST NAME KRISTIN MIDDLE M
INITIAL
17❑ STREET �', 1150 UNION AVE NE APT 5-4 CITY RENTON ST WA Zip 98059 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK Y�EsI I I NOF YEs t l NO�
19 LICENSE# STATE WA ]SEX IF M D.C.B. 10 _ 16 _ 1978 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CVD0253 TAre WA VIN1i 3MVDMBDM5RM679044
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2024 MAKE MAZp MODEL CX-30 STYLE Sp VEHICLETOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KRISTIN JARVIS 1150 UNION AVE NEAPT 5-4 RENTONWA98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POLICY#E CO PROGRESSIVEIN I STOP 5
'E""LE ❑ N,J� CITATION# CHARGE
LEGAL i o BOTTOM
LY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH13024
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4249
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'
26-4249 ACC
On 6/2/2026 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two-vehicle, non-injury, non-blocking collision that
had occurred in the 3700 block of NE 4th St Renton/King/WA. The caller advised they had pulled into
a nearby parking lot.
I arrived on scene and located both drivers and confirmed there was no injury.
The driver of the 2012 Kia Soul WA/CTE4770 (Unit 1) was identified by his WADL as Maximo A
Viloria Chinchilla DOB: 7/29/1988. Maximo spoke limited English, so we communicated through a
translation app. He said that he was driving east in the #2 lane of NE 4th St and wen to change lanes
to the #1 lane and struck Unit 2. There was damage to the passenger side doors and front and rear
quarter panels of the Kia. There was no airbag deployment and the vehicle was drivable.
The driver of the 2024 Mazda CX-30 WA/CVD0253 (Unit 2) was identified by her WADL as Kristin M
Jarvis DOB: 10/16/1978. Kristin said that she was driving east in the #1 lane of NE 4th St when Unit 1
changed lanes and struck her. There was damage to the front driver's side wheel, quarter panel, and
door. There was no airbag deployment and the vehicle was drivable.
I cited Maximo for RCW 46.61.305 Unsafe Lane Change under Sector citation #6A0092350. This
citation should be mailed to his DOL address.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that he foregoing is true
and correct.
D. Nelson #191 6/2/2026 Renton WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 06-05-26 02:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
X LANE 10008 1 6/17/2026 1:38:58 PM
BADGE OR ID# 12421 OR]#' WA0171300 TIME POLICE DISPATCHED 10:14 AM TIME POLICE ARRIVED';10:18 AM
PART I PAGE IT]OF
REPORTNO.! EH13024 CASE# 26-4249 DATE AND TIME 06/02/2610:07
OF COLLISION
of
r
a
a
4 1
s
c
t
)
t
Av;
a
PAGE 3 OF 3