HomeMy WebLinkAbout25-9960 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG58047 170
27
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 2$-9960 z $ 1
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3❑HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE nF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 11 - 1-- 2025 1407 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MIAN AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ,❑ FEET ❑ S ❑ W e S 3RD ST
❑ �
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257606632 0 11
30
6� LAST NAME BUSH FIRSTNAME JACOB MIDDLE A 1 2 31
INITIAL
STREET ❑✓ 1020 112TH ST SW CITY EVERETT ST WA ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
❑10❑ P1 aTES� CCN1248 sTArr WWAurN# 3FA6POSU4ER256760 3
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 1 7 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 1 2014 FORD FUSION SD DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO SAMUEL MCENTIRE 14310 176TH AVE SE RENTON INA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE❑ NSURANCE CO <53 4
LI EFFECT l POLICV# Q
VENICLE CHARGE 36
YEs No clTAnoN# 5A0592952,5A0592952, DWLS 3RD DEGREE,FAIL TO
15❑ STANDING 7
MOTOR PEDAL pROpERTy DAM THR OLD MET PHONE
UNIT a2 ❑✓ ❑ PEnESTR,AN ❑ ❑ D:2065549395
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME NAVARRETE HERNANDEZ FIRST NAME MARTIN MIDDLE
INITIAL
17 STREET I❑ s❑' 1319 15 TH AVE S.APT 15 CITY' SEATTLE ST WA ZIP 98144 4❑ 37
NEW AnoREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LDIIVER # STATE WA SEX M M .C.B. 10 _ 08 _ 1979 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BRW0190 TArE 41
WA VIN1 5N1DR2MM9KC576943 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE NIS5 MODEL PATHFIN STYLE UT I VEHICLE TOWED TO BLIN TOWEDBv GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARIA JUAREZ SALGADO 131915TH AVE S,APT 15 SEATTLEWA98144 D:2065549395 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 5231508-D27-47AIN STOP 5
'EwCLE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' a
7NE
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ON 12327 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG58047
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9960
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JUAREZ SALGADO MARIA A
(LAST FIRST,
ADDRESS&PHONE#
22418 30TH AVE S,APT 102 DES MO/NES WA 98198 SEXi F MMDOYyrv1985
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 2 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 17 CHEST PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL) NAVARRETE HERNANDEZ VENTURA
ADDRESS&PHONE# D O B
1319 15TH AVE S,APT 15 SEATTLE WA SEX' U MI,DDYyvv 09 _ O6 _ 1959
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER
Z WITNESS� UNIT# 2 POS 9 AIRBAG'2 RESTR. 4 EJECT 1 USE 2 CLASS 7 CHESTPAtN
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.
T.NELSON 11-16-25 03:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 12/12/2025 10:13:43 AM
BADGE OR ID# 12327 OR]# WA0171300 TIME POLICE DISPATCHED Y:07 Pry] TIME POLICE ARRIVED Y:07 Pry]
PART I PAGE IT]OF 4�
REPORT NO. EG58047 CASE# 25-9960 OF COLLISION
11/16/25 14:07
OF CbLLI510N
NARRATIVE
25-9960
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 11-16-2025 at approximately 1407 hours I was at S 3rd St and Main AVE S, facing south at a red
light on Main AVE S. I heard a vehicle sound their horn multiple times, then heard the sound of two
vehicles colliding. I looked to my right (the west) and observed that unit 1 had attempted to make a
right turn onto S 3rd St, a one-way eastbound street, to travel west and struck unit 2 head on which
was travelling east.
Both unit 1 and unit 2 sustained front end damage. Both vehicles were still operable.
I activated my emergency lights, and both units relocated to S 3rd St and Mill AVE S.
I contacted the driver of unit 1, Bush. Bush advised that he was not injured. Bush returned with a
driver's status that was suspended in the 3rd degree. Bush said that he knew he did not have a valid
driver's license, but did not know that it was suspended. Bush did not have insurance on the vehicle
and advised that he purchased the vehicle approximately 7 months ago and had not transferred the
title.
I contacted the occupants of unit 2. The driver, Martin, advised that he was okay, but both
passengers Maria and Ventura complained of chest pain. The Fire Department responded and
cleared Maria and Ventura of any emergent medical issues.
Bush confirmed his mailing address, and I advised that he would be receiving a citation for numerous
violations.
Bush contacted a friend who moved the vehicle to a legal parking stall.
Unit 1's improper turn on a one-way street and inattention was the proximate cause of the collision.
Bush was cited for DWLS 3rd degree, failure to transfer the title within 45 days, operating a motor
vehicle without insurance, inattentive driving, and wrong way driving on a one-way street.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by T. Nelson 12327 on 11-16-2025 at 1535 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EG58047 CASE# ' 25-9960 DATE AND TIME 11/16/25 14:07
OF COLLISION
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