HomeMy WebLinkAbout26-5432 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-5432 z
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 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 07 - 1-- 2026 1916 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
116TH AVE SE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SE PETROVITSKY
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066377129 0 11
30
6� LAST NAME MAY-ROMAN FIRSTNAME ISABELLA MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 17134 120TH TER SE U-101 CITY RENTON ST WA 2jp, 98058 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 3 RESTR 4 EJECT 1 1 INJURY H USE ET 2 CLASS 6 [NATURE OF INJURIES
SORE FROM SEA TBELT z❑
3
10[1 PI ATNE 14 CGT3705 sTAr WAvN# 1N4At21E19N561833
- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 1 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 5 1 34
13 2 2009 NISS ALTIMA SD DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4175230152 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2095197370
16 a
LAST NAME WALKER FIRST NAME LATHAN MIDDLE JA
INITIAL
17❑ STREET NEW ADDREss❑' 18807 124TH AVE SE CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK vEs It I NOF YES
t l NOF,/
19 RRS LDI IVE STATE WA SEX M M .C.B. 08 _ 17 2006 39
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑LICENSE 21❑ PLA E# CVC8327 TArE 41
WA vIN# KMHM34AC3PA028867 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2023 MAKE yyU/I/ MODEL /ON/(,�6 STYLE $D DAMAGE TO ✓WED NO GENE MEYER YES NoO BLIN TOWED By OV 44
H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO USAA 0543734637102IN STOP 5
vEHICLe ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`[J
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH2O989
COLLISION REPORT III III III III III 111
1591972 CASE# 26-5432
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JACKSON LARRISSA A
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
12834 SE 175TH CT RENTON WA 98058 2062803934 SEXi F MMDDYyry 12 - 24 - 2004
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ �, 2 POS, 3 3 4 1 USE 2 CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEXt MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY 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'
26-5432
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 07-12-2026 1 was working as a police officer in the city of Renton. At approximately 1918 hours I
was dispatched to the report of an injury collision at the intersection of SE Petrovitsky Rd/116th Ave
SE, City of Renton, County of King, WA. This incident was captured on my department issued Axon
body camera.
According to the notes in the call, two vehicle collision and one injured.
I arrived on scene where Renton Fire was already on scene. They reported no injuries and cleared
everyone involved medically.
I spoke to the driver of Unit 1. She explained she was turning east on SE Petrovitsky Rd from 116th
Ave SE and had a solid green arrow. As she entered the intersection, she collided with Unit 2 who
was travelling north through the intersection. The driver of Unit 2 said he had a green light and had
the same story as the driver of Unit 1.
Both vehicles were towed by Gene Meyer towing and I provided both parties with case numbers. Due
to the conflicting stories, I could not establish the proximate cause of the collision.
There is no further information available at this time.
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 S. Fajarillo #12847 on 07/12/2026 @ 2029 hours in Renton WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
STEVEN FAJARILLO 07-12-26 08:35 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 7/15/2026 10:29:49 PM
BADGE OR ID# ` 12847 OR]#+ " WA0171300 TIME POLICE DISPATCHED; 7:98 Pry] TIME POLICE ARRIVED'7:24 PM
PART I PAGE IT]OF 3�
REPORT NO. EH2O989 CASE# ' 26-5432 DATE AND TIME 07/12/26 19:16
OF COLLISION
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