HomeMy WebLinkAbout25-5759 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG08059oc� RA
COLLISION REPORT 1591971
CASE# 25-5759 2
INTERSTATE CITY STREET❑ FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3
HIT&RUN CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 1 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCLson' 07 - 02 - 2025 1525 17 =.= S 8 W e IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e 311 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
6 1001.1 00 FEET e✓ S 8 NI e N 3RD ST
1 5 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2067324826 1 5 30
6 LAST NAME VARELA ORTEZ FIRST NAME LUIS MIDDLE D 1 1 2 31
INITIAL
STREET ❑✓ 3900 VETERANS WAYE2 CITY; KENT ST WA ZIP; 98032 2
NEW ADDRESS
7� +CDL RES IGNITION REQUIRED IGNITION PENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ✓NO INTERLOCKVEs NO✓ YES NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 10 — 22 — 2005 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CEX2284 STATE WA VIN# 2HGEJ6614YH541387 3
10 Fq I as ATP tt
TRAILER
11 0 5 STATE TRAILER STATE PLATE# PLATE# ROM To
TRLR rRLR 0 0 33
12 O 5 VIN#' VIN#
FROM TO
VEH.YEAR ZOOO MAKE yOND MODEL C/VlC STYLE P4 VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE O O 34
13 DAMAGE YES NO YESE] NO
REGISTERED OWNER INFO LUIS VARELA ORTEZ 3900 VETERANS WAY E2 KENTWA98032 D:2067324826 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
❑ INSURANCE CO 2 3 4
14 LIABILITY INSURANCE NONE NONE
IN EFFECT &POLICY# i 4TOP 5
VEnic�E CHARGE 7 0 80TTOM 36
15
Lrn Lyc YES❑NO❑ CITATION# 5A0563863,5AO563864, DWLS 3RD DEGREE,OP MOT VEH s 7
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2066973824
16�
LAST NAME JONES FIRST NAME DEREK MIDDLE D
INITIAL
STREET ❑ 37
17 ❑ 8530136 STREET CT E CITY', PUYALLUP ST, WA ZIP 983736410 4
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs No✓ INTERLOCK YES No✓ vEs No✓
19 DRIVER'S ' STATE WA SEX M D.O.B. 12 28 1974 � 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJURY
1 NATURE OF INJURIES 40
21 LICENSLATE E CLT2167 raTE WA vIN# KNDADFS50R6028721 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2024 MAKE KJA MODEL EVg STYLE P4 VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO DEREK JONES 8530136TH STREET CTE PUYALLUP WA 983736410 D:2066973824 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 5487559D2647C
IN EFFECT &POLICY# t STOP
YemaE LE—LY YES❑ N`.L J
,.I—I CITATION# CHARGE to BOTTOM
25 s
7DNE
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SON 12421 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG08059
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5759
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) AREVALO ADRIANA M
ADDRESS&PHONE# D�
3900 VETERANS WAY E2 KENT WA 98032 2067324826 SEXi F MMDDYYYY 04 — 03 — 2006
PASSENGER Z WITNESS[:] UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 3 2 4 1 USE 2 :CLASS ;1 � ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL}
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I 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.
D.NELSON 07-03-25 05:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 7/9/2025 7:53;04 AM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:27 PM TIME POLICE ARRIVED i 3:42 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG08059 CASE# 25-5759 DATE OF COLLI r�510NN + 07/02/25 15:25
L1
NARRATIVE
25-5759 ACC DWLS
On 7/2/2025 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 collision which had occurred in the
parking lot of Burger King at 311 Sunset Blvd N Renton/King/WA. An involved party was calling to
report that there had been a collision in the parking lot and the other party was refusing to exchange
information.
I arrived on scene and located both drivers, there were no injuries.
I spoke with the driver if Unit 1, a silver 2000 Honda Civic WA/CEX2284. The driver was identified by
his WADL as Luis D Varela Ortiz DOB: 10/22/2005. Luis spoke minimal English so his passenger,
identified by her WADL as Adriana M Arevalo Segovia DOB: 4/3/2006, translated.
Adriana said that they were backing out of a parking space and saw that Unit 2 was also back up from
the opposite side of the lot. She said that they stopped ad honked their horn, but Unit 2 did not stop
and struck them on the driver side rear fender. The Civic had damage to this rear driver side bumper.
Luis said that he recently bought the vehicle and did not have any insurance on it yet. A DOL check
also showed that the Civic had an expired registration as of 9/13/2024.
1 then spoke with the driver of Unit 2, a 2024 Kia EV9 WA/CLT2167. He was identified by his WADL
as Derek D Jones DOB: 12/28/1974. Derek said that he was backing out of his parking stall and was
struck by Unit 1. There was damage to the Kia on the driver side rear bumper.
The damage was minimal and both vehicles were drivable.
A check of Luis's driving status showed that he was DWLS 3rd Degree, A check of his driving
abstract showed that he had two unresolved citations #4A0843305 from 11/29/2024 and #5A0214967
from 1/20/2025. His license showed as suspended beginning on 11/11/2023 under citation
#3A0582773.
I advised Luis that he was under arrest but that I was not going to take him to jail. I asked if he could
produce a licensed driver to take the Civic. Brenda Y Segovia DOB:11/29/1985 arrived and I
confirmed her driving status was valid.
confirmed Luis's address as 3900 Veterans Way#E2 Kent WA and advised him his tickets would be
mailed to him. I provided him with an exchange of information and advised him he was free to leave.
I completed Sector citation #5A0563863 for DWLS 3rd Degree RCW 46.20.342.1 C and citation
#5A0563864 for Operating a Motor Vehicle Without Proof of Valid Insurance RCW 46.30.020 and
Failure to Renew Expired Registration Greater than 2 Months RCW 46.16A.030.5.0.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 7/2/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG08059 CASE# 25-5759 DATE AND TIME 07/02/2515:25
OF COLLISION
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