HomeMy WebLinkAbout26-4808 TFFiNouCERA II I III 1 III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
SASE 26-4808 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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'. 06 - 1-— 2026 0839 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
MAIN AVE S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:8483912244 0 11
30
6� LAST NAME MENDOZA FIRSTNAME VILMA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 23353 SE 284TH ST CITY MAPLE VALLEY ST WA ZIP 98038 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'F MID
.O B 06 1— 21 — 1970 1 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit BHY2001 sTArI WA urN#' 2HKR W2H87HH686256
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 1 2017 HOND CR-V EX D
SV AMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO VILMA MENDOZA 23353 SE 284TH ST MAPLE VALLEY WA 98038 D:8483912244 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE NSURANCE CO STATEFARM 576 1472.811.47
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 5 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4256810120
LAST NAME COLLINS FIRST NAME WILLIAM MIDDLE G
INITIAL
17 STREET❑ NEW ADDRESS❑' 420 CEDARAVES CITY RENTON ST WA ZIP 98057 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK ves I I No� YEs F NDF,/]
19 LDI IVERI # STATE WA SEX M M D.O.B. 02 _ 09 _ 1945 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLATE# 15591A TArE 41
WA VIN1 84293290 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
YEAR 1957 MAKE DODG MODEL PICKUP STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
VEH
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO WILLIAM COLLINS 420 CEDAR AVE S RENTON WA 98057 D:4256810120 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO STATEFARM 005 3896-C20-47IIN 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
RAYMOND WATSON 13127 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH14083
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4808
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'
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.
RAYMOND WATSON 06-20-26 09:31 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 6/21/2026 2:10:33 PM
BADGE OR ID# 13127 ORI# WA0171300 TIME POLICE DISPATCHED 8:42 AM TIME POLICE ARRIVED 8:43 AM
PART I PAGE IT]OF 4�
REPORT NO. EH14083 CASE# 26-4808 OF COLLISION
06/20/26 08:39
OF CbLLI510N
NARRATIVE
26-4208
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 06/20/2026 at approximately 0842 hours, myself, Officer R. Watson, was dispatched to a collision,
no injuries, non-blocking, at the intersection of Houser Way S and Mill AVE S, within the City Limits of
Renton, County of King, State of Washington.
Dispatch notes stated that it was a 2-vehicle collision with no injuries and non-blocking.
I arrived on scene and observed two vehicles stopped in the right lane with another officer present.
Unit# 1, driven by Vilma D. Mendoza (DOB 06/21/1970) verified by WA DOL photo, stated she was
driving a White Honda CRV, WA plate BHY2001. There were no other passengers in the vehicle.
Vilma stated that she was traveling eastbound on S 3rd ST when the light changed quickly and she
collided with unit#2. Vilma said she had no injuries and declined aid. When I asked for Vilma's
license, registration and insurance, she was able to provide me with all documents. Unit#1 had
moderate right-side damage, no airbag deployment, and was able to be driven from the scene.
Unit# 2, was driven by William G. Collins (DOB 02/09/1945) verified by WA DOL photo, stated he
was driving a Green 1957 Dodge Pickup, WA dealer plate 15591A. There were no other passengers
in the vehicle. William said he was traveling on Main AVE S when unit#1 went through a redlight and
collided with him. Willaim said he had no injuries and declined aid. When I asked for William's
license, registration and insurance, he was able to provide me with all documents. Unit#2 had no
damage, no airbag deployment, and was able to be driven from the scene.
An exchange of information was given to both parties involved.
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 by Officer R. Watson #1 31 27 06/20/2026 0926 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO.! EH14083 CASE# 26-4808 DATE AND TIME 06/20/26 08:39
OF COLLISION
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PAGE 4 OF 4