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Home My WebLink About25-8567 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 25-8567 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK STREET LIGHT POLE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 10 - 1-- 2025 0843 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE CARR RD BLOCK NO. e✓ 10600 ❑ 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e 106TH PL SE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2067887566 0 4 30 6� LAST NAME PICKENS FIRSTNAME JENNIFER MIDDLE A 1 2 31 INITIAL STREET ❑ 17735 105TH PL SE APT I201 CITY RENTON ST I WA ZIPI 980558413 1 z 'NEWADDRESS 7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YES 1/ NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑ USE CLASS j I LEFT HAND LACERATION/HEAD PAIN 3 10[1Pl QTNFS# B WS3323 STATE WA VIN If 1 FMSK8DH6LGB55029 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR 2020 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE 34 13 FORD EXPLOR 4D DAMAGE YES NO � RS TOWING 3 5 YES❑ No✓ REGISTERED OWNER INFO JENNIFER PICKENS 11131105TH PL SE APT K101 RENTON WA 98055 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 ABILI INSURANCE INSURANCE CO BRISTOL WEST G01 646739200 �3g 4 IN EFFECT &POLICY#VEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA. YES 1/ NO D:2062557278 16 a LAST NAME HENRIQUEZ CASERES FIRST NAME DELMI MIDDLE X INITIAL 17❑ STREET ❑', 17804 98TH AVE S CITY RENTON ST WA ZIP 980555734 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 LDI IVER # STATE WA SEX F M .C... 04 05 _ 1984 El 39 HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑ 21❑ LICENSE I CNC6816 TATE I WA VIN# 5NPD84LF1JH230085 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2018 MAKE HYUN MODEL ELANTRA STYLE SD I VEHICLE TOWED TO BLIN TOWEDBY G.. HI 44 24❑ DAMAGE YES�/ NO BANKERS TOWING YES No�/ REGISTERED OWNER INFO DANIEL DELGADO CANDRAY 18401 ALPINE WAYE PUYALLUP WA 98374 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE❑ INSURANCE CO NONE NONE IN EFFECT &POLICY# 0( 9TOP 5 VEHICLE res� Nc❑ CITATION# 5A0723026,5AO723026 CHARGE OP MOT VEH W/OUT INSURANCE,NO ,o BOTTOM LEGALLY `LJ 25 ' a 7NELSON NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12421 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG35531 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8567 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MINGO TREYDENI (LAST FIRST, ADDRESS&PHONE# D O.B. ' 17735 105TH PL SE APT 1201 RENTON WA 98055 2067887566 SEX M MMDovyry 02 - 28 - 2011 {� SEAT HELMET INJURY NATURE OF INJURIES PASSENGER Z WITNESS UNIT# 1 POS 3 AIRBAG;3 RESTR. 1 EJECT 1 USE 2 CLASS 16 COMPLAINT OF NOSE PAIN NAME (LAST,FIRST,MIDDLE INITIAL) GALEANO HENRIQUEZ LYANNI G ADDRESS&PHONE# D O B 17804 98TH AVE S RENTON WA 980555734 2062557278 SEX'. F MMDDvvvv 12 _ 26 _ 2012 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER Z WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&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. D.NELSON 10-03-25 05:00 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE RAYMOND GORAJEWSKI 12399 1 101812025 8:33:15 AM BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED 8:45 AM TIME POLICE ARRIVED:8:48 AM PART I PAGE IT]OF 5� REPORT NO. EG35531 CASE# 25-8567 OF COLLISION 10/03/25 08:43 OF CbLLI510N NARRATIVE 25-8567 ACCINJ On 10/3/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the City of Renton. I was dispatched to a collision with injury in the intersection of SE Carr RD and 106th PI SE Renton/King/WA. Two involved parties were calling in advising there was injuries, and they were blocking the intersection. I arrived on scene and RRFA was on scene and evaluating all patients. The driver of the 2020 Ford Explorer WA/BWS3323 (Unit 1), was identified by her WADL as Jennifer A Pickens DOB: 7/26/1979. Jennifer said that she was driving east on SE Carr Rd in the #1 lane. She said that she had a green light and was entering the intersection when Unit 2 turned in front of her causing the collision. The Ford collided with the Hyundai and then rolled into a nearby utility box, this secondary collision knocked out all traffic and pedestrian signals in the intersection. There was front airbag deployment in the Ford and damage to the front bumper, hood, and driver side door and front quarter panel. Jennifer was able to provide me with all necessary information and a DOL check showed she was clear and valid. Jennifer had a small laceration to her left hand from the airbag deployment and complaint of head pain. The passenger in the Ford, Treyden I Mingo DOB: 2/28/2011, was not wearing a seatbelt at the time of collision and had a complaint of nose pain. Both were evaluated by RRFA on scene and transported to VMC for further evaluation by Tri Med. The driver of the 2018 Hyundai Elantra WA/CNC6816, was identified by her WADL as Delmi X Henriquez Caseres DOB: 4/5/1984. Delmi said that she was in the left turn lane from westbound SE Carr Rd to turn south onto 106th PI. Delmi said that she had a green arrow for her left turn and when she entered the intersection and was struck by Unit 1. There was no airbag deployment in the Hyundai and there was heavy damage to the front bumper and hood. Delmi and her passenger, Lyanni G Galeano Henriquez DOB: 12/26/2012 were evaluated by RRFA on scene and cleared. Lyanni had a complaint of pain to her left hip area. Both vehicles were removed from the scene by Bankers Towing. I completed a Sector Impound form for the Ford. Delmi advised she did not have insurance for the Hyundai and a DOL check showed her license status as "Not Licensed -Eligible". I completed Sector citation #5A0723026 for Operating a Motor Vehicle Without Proof of Valid Insurance RCW 46.30.020 and No Valid Operators License with Valid ID RCW 46.20.015. This citation should be mailed to Delmi's DOL address. There were no independent witnesses, traffic cameras, or dash cameras that captured the collision. was not able to determine who had the green light to enter the intersection. 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 10/3/2025 Renton WA PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EG35531 r`I POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 25-8567 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:4254307500 MIDDLE.. 29 LAST NAME RENTON FIRST NAME CITY OF INITIAL STREET 30 NEW AnDRFSP 1055 S GRADY WAY CITY RENTON ST WA ZIP 98057 6 II 1 31 CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T DRIVER'S STATE I SEX U M��DYSYv' -� 2 LICENSE 7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE ICLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. D.NELSON 10-03-25 05:00 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 12421 O#I',WA0171300 APPROVED BY 10%8/2025 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EG35531 CASE# 25-8567 DATE AND TIME 10/03/25 08:43 OF COLLISION j � t i 8. ton 4 04 1, Sffi��r"t".�yf i \i2 3i y h2 zt s ` �t n j 4D i .;- v<< PAGE 5 OF 5