HomeMy WebLinkAbout25-6124 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG16642 170
27
COLLISION REP FIT 1591971
CASE 25-6124 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 07 - 16 - 2025 1530 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N SUNSET BLVD BLOCK NO. e✓ 350
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET MILES e S B W e N 3RD ST 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2069010875 2 01
30
6❑ LAST NAME GONZALEZ PEINADO FIRST NAME JARVI MIDDLE H 1 2 31
INITIAL
STREET ❑✓ 8801 AURORA AVE N APT 3 CITY SEATTLE ST WA 2jp, 98103 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
$ LDRIVER # STATE WA SEX'M MMDDYY 02 - 24 - 2004 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� CSG1428 sTArI WAVIN# KMHCU4AE4EU767574
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2014 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 5 34
13 HYUN ACCENT P4 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JARVIGO.,Ez PEIN4D08801 AURORA AVE N APT 3 SEATTLE WA 98103 D:2069010875 VEHICLE NO. 1 ❑
INSURANCE CO
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE
14 ❑ NO INSURANCE NO INSURANCE
IN EFFECT &POLICY# 9TOP
VE—LE 5 36
LECALLv YES❑NO❑ CITATION# CHARGE
1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO 1/ RO 2134473669
16 2
LAST NAME CHANG FIRST NAME KAREN MIDDLE L
INITIAL
17 STREET❑ NEW ADDRESS❑' 13819 SE FAIRWOOD BLVD CITY RENTON ST WA ZIP 98058 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA ]SEX IF M .C... 05 _ 13 _ 1978 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CDK5957 TArE WA VIN# 41
JF2SJABC6HH437843 1
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2017 MAKE SUBA4 MODEL FORESTS STYLE P4 VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO%/ YES NO
REGISTERED OWNER INFO KAREN CHANG 13819 SE BLVD RENTONWA 98058 D:2134473669 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 4960329132647AIN I STOP 5
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY N
25 a
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. EG16642
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6124
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 07-21-25 02:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 8/6/2025 8:18:06 PM
BADGE OR ID# 13127 OR]#' WA0171300 TIME POLICE DISPATCHED 3:41 PM TIME POLICE ARRIVED',3:45 PM
PART I PAGE IT]OF 4�
REPORT NO. EG16642 CASE# 25-6124 OF COLLISION
07/16/25 15:30
OF CbLLI510N
NARRATIVE
25-6124
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 07/16/2025 at approximately 1541 hours, myself, Officer R. Watson, was dispatched to a collision,
at WESCO Autobody, 350 Sunset BLVD N, within the City Limits of Renton, County of King, State of
Washington.
Dispatch notes stated two vehicles were involved, no injuries and it was non-blocking.
I arrived on scene and observed two vehicles pulled into the parking lot in front of Gourmet Coffee
with the occupants standing outside the vehicle.
Unit#1 driven by Jarvi H. Gonzalez Peinado (DOB 02/24/2004) verified by WADOL photo, stated that
he was driving the White 2014 Hyundai Accent, WA Plate# CSG1428, south bound in the center turn
lane. He attempted to make a right-hand turn onto Sunset BLVD N, to travel south when he collided
with Unit#2. He said he had no injuries and declined aid. When I asked for his license, registration
and insurance for the exchange of information, he was only able to provide me with a WA State
Identification Card. He said he did not have the registration to the vehicle and that the vehicle did not
currently have insurance. Unit#1 had moderate damage to the passenger side doors.
Unit#2 driven by Karen L. Chang (DOB 05/13/1978) verified by WADOL photo, stated that she was
driving the Blue 2017 Subaru Forester, WA plate# CDK5957, in the number 2 lane south bound. She
turned into the number 3 lane when Unit#1 collided with her vehicle. She claimed to not have any
injuries and declined aid. When I asked for her license, registration and insurance for the exchange of
information, she provide all documentation. Unit#2 had minor front-end damage.
Neither vehicle had to be towed from the scene and Jarvi contacted a licensed driver to drive the
vehicle from the parking lot where they had pulled into. An exchange of information was completed
and provided to each party. Jarvi was also informed he would be receiving citations in the mail for not
having valid insurance and no valid operator license with ID, citation # 5A0571188.
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 #13127 07/21/2025 1425 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO.! EG16642 CASE# ' 25-6124 DATE AND TIME 07/16/25 15:30
OF COLLISION
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