HomeMy WebLinkAbout25-8450 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-8450 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
COLLISION'. 09 - 1-— 2025 1638 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BL
SW SUNSET BLVD
OCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2068499473 0 11
30
6� LAST NAME ARVISO FIRSTNAME DIANE MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 13506 99TH AVE E APT 5-202 CITY PUYALLUP ST I WA Zjp, 983739196 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ P1 ATE 14 D77310E STATE WA u N# 1GCRKSE34BZ225701
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 8 5 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2011 CHEV SILVER DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LUCIANA HUNTER 3111 S 192ND ST SEATAC WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICV# m
LEGA LE CHARGE 5 36
LECALLv res❑NO❑ CITATION#
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:][LAM ES 1/ NO D:2069819234
16 a
LAST NAME DELA PENA FIRST NAME GLENN MIDDLE IG
INITIAL
17❑ STREET ❑', 6433 N AMHERST ST CITY PORTLAND ST OR ZIP 97203 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19 DRIVER'S STATE OR SEX M I D.Q.B. 03 _ 17 1997 El 39
LICENSE# MMDDYY
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE 803PPE TATE OR vIN1 USE
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
TOWED BY Gov HI 44
VEH YEAR 2019 MAKE S'(JB�Q MODEL CROSSJ' STYLE GA DAMAGE TOWED NOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE I PORGY#ECO LIBERTY MUTUAL AOV26131302495 1 9TOP 5
IN EFFECT
VE""LE ❑ Nu,J CITATION# CHARGE
LEG i o BOTTOM
ALLY YES
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG38123
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8450
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
PM 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 FIRST 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.
C.CATALAN 10-14-25 05:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 1011612025 7:17:25 AM
BADGE OR ID# 12007 OR]4$ WA0171300 TIME POLICE DISPATCHED 4:40 PM TIME POLICE ARRIVED',4:43 PM
PART I PAGE IT]OF 4�
REPORT NO. EG38123 CASE# 25-8450 OF COLLISION
09/29/25 16:38
OF CbLLI510N
NARRATIVE
On September 29, 2025, at 1638 hours dispatch requested that I respond to a two-vehicle collision
that occurred at the intersection of Rainier Ave S and S 3rd St, in the city of Renton, county of King,
and state of Washington.
Upon my arrival I spoke with the driver of Unit 1, identified as Diane Arviso, and she explained that
prior to the collision she was traveling southbound on Rainier Ave S in lane 2 of 4. Diane intended to
continue straight through the intersection of S 3rd St. When Diane entered the intersection, both Unit
1 and Unit 2 collided in the middle of the intersection. Diane stated that Unit 2 failed to maintain their
lane and struck her vehicle while moving. Diane stated Unit 2 was in lane 3 of 4 and merged into lane
2 of 4 which she was occupying. Unit#1 sustained moderate damage to their passenger side rear
fender and Diane declined having any medical injuries.
I then spoke with the driver of Unit 2, Glenn Dela-Pena, and he relayed a similar story. Glenn
explained he was traveling southbound on Rainier Ave S and approaching the intersection of S 3rd
St. Glenn also stated he was traveling in lane 2 of 4 but mentioned that Unit 1 was in the left turn lane
(lane 1 of 4). As he traveled south through the intersection, he believes Unit 1 failed to make their left
turn and instead merged right into his driver's side fender and door. Unit 2 also sustained moderate
damage and declined having any injuries.
I was unable to review the video footage at the intersection, so this an informational report only.
I cannot determine who committed the traffic violation.
An exchange of information was provided to the two drivers and no tows were required.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
C. Catalan 10/13/2025 Renton
PAGE 3 OF 4
REPORT NO. EG38123 CASE# ' 25-8450 DATE AND TIME 09/29/25 16:38
OF COLLISION
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PAGE 4 OF 4