HomeMy WebLinkAbout25-308 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE zs-3o8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING'
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF 02 OBJECT 1 1 8 28
UNITS
RESERVATION I
STRUCK
2
3 DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 01 - 09 - 2025 2215 17 ❑.❑ S IN 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
AIRPORT WAY
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S ❑ W e RAINER AVE S
0 5 29
MOTOR PEDAL- DAMETHRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
AG NO D:2063840071 0 1 30
6 LAST NAME VEGA LOPEZ FIRST NAME JESSICA MIDDLE P 1 1 2 31
INITIAL
STREET ❑ 200 SW 5TH PL APT G302 CITY RENTON ST WA ZIP 980575816 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NOWINTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 06 - 03 - 1995 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ PICENSE11 ATF 14 BKZ8157 STATE WAa VIN# 5YFBU4EEXCP066459
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 7 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13FAl 2012 TOYT COROL SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO JESSICA VEGA LOPEZ 200 SW5TH PL APT G302 RENTON WA 980575816 D:2063840071 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 137.1437-D22.476 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YEs No clTAnoN# 5A0108760 SUSPENDED LICENSE-FAIL o eorrom
15❑ STANDING 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE. ❑ ❑ OWNFR ❑ YES 1/ NO D:4252727207
16 a
LAST NAME HERNANDEZ PAREDES FIRST NAME JORGE MIDDLE JA
INITIAL
17❑ NEW STREETREss❑' 11101 SE 206TH ST APT 311 CITY KENT ST WA ZIP 98031 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t l NoF,/
19[—] DRIVER'S STATE WA SEX M D.C.B. 07 19 _ 1991 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# A7982490 TATE 41
WA VIN# 1C6SRFFT4KN528009 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE RAM MODEL 1500 STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JORGE HERNANDEZ PAREDES 11101 SE 206TH ST APT 311 KENT WA 98031 D:4252727207 VEHICLE NO.2
SHADEd DAtYGE$�dAREA
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 963254145IN 1 4� 9TOP 5
VEHICLE ❑ C[ CITATION# CHARGE 1oBOTTOM
LEGALLY YES N
25 s a
7KEV
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EF56031
COLLISION REPORT III III III III III 111
1591972 CASE# 25-308
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'
I was dispatched to a collision on 01/09/25 at 2217 hours at Airport Way and Rainer Ave S, in city
Renton, King County WA.
Unit 1 BKZ8157 Driver: Jessica P. Vega-Lopez (DOB 06/03/1995)
Unit 1 A7982490 Driver: Jorge A. Hernandez-Paredes (DOB 07/19/1991)
Unit 2 stated that he turned East onto Airport way off Rainer Ave S and was in lane 2. Unit 1 then
suddenly attempted to make a U-turn from lane 1 turning into the passenger side of his vehicle. Unit 1
stated that she turned off Rainer Ave S onto Airport Way traveling East in lane 1. She said that the
truck was behind her at that time, and she turned on her signal to turn left and make a U-turn. She
said that the truck sped up next to her and when she went to turn, she hit the truck.
Both drivers stated no injuries on scene.
Both Units were given the case number and information exchange as reference.
Driver of unit 1 Vega-Lopez was cited for driving a motor vehicle while having a suspended/ revoked
license in the 3rd Degree.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 01/09/2025, 2342 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 01-09-25 11:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 111412025 5:27:22 PM
BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 10:17 PM TIME POLICE ARRIVED',10:21 PM
PART B PAGE IT]OF 3�
REPORT NO. EF56031 CASE# 25-308 DATE AND TIME 01/09/25 22:15
OF COLLISION
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