HomeMy WebLinkAbout25-80002 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 25-80002 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4900 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 CITY# ❑
cowsloN 11 - 19 - 2025 0751 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 1. 00 FEET MILES e S B W e N 8TH ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2064603787 0 6 30
6 LAST NAME PERDOMO LINARES FIRSTNAME ROYMAR MIDDLE A 1 1 2 31
INITIAL
STREET 01 345 PACIFIC AVE N APT MM-05 CITY PACIFIC ST WA ZIP 980471233 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� CPC9731 sTATI WAVIN# 1 FTNR2CM6FKA14150
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2015 FORD TRANSI MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO J.HERNANDEZLARA 3LI5147THAVE SW FEDERAL WAY WA 98023 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE SCOTTSDALE INSURANCE 41297/22608
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 10BOTTOM 5 36
EGHALLY YES❑NO CITATION# 5AO882638,5AO882638 NO VALID OPER LICENSE WITH
15❑ STANDING 8 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:7752257671
16 a
LAST NAME LUBANDI FIRST NAME IMELDA MIDDLE I C
INITIAL
17❑ STREET ❑', 7428 125TH AVE SE CITY NEWCASTLE ST WA ZIP 980561206 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER # STATE WA SEX F MMDDW O6 _ 03 _ 1956 39
CENS —NATURE OF INJURIES
H USE CLASS
NJAURSY COMPLAINT OF NECK PAIN 40
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7
21❑ LICENSE BAK8176 TATe WA vIN# 3GYFNEE38GS585693.
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
I
VEH YEAR 2016 MAKE C/a DI MODEL SRX STYLE DAMjVEHlAGE TO WED NOO✓ BLIN TOWED BY GOV 44
Yr
H YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO ALLSTATE 964 069 654IN 1 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG59039
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80002
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 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.
D.NELSON 11-21-25 04:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/15/2025 2:10:29 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 7:54 AM TIME POLICE ARRIVED',7:54 AM
PART I PAGE IT]OF 4�
REPORT NO. EG59039 CASE# 25-80002 OF COLLISION
11/19/25 07:51
OF CbLLI510N
NARRATIVE
25-80002 ACC
On 11/19/2025 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, non-injury, non-blocking collision near
LA Fitness at 715 N Landing Way Renton/King/WA. An involved party was calling to report that it had
been a two-vehicle collision that had moved off the roadway.
I located both parties in the parking lot of LA Fitness, the driver of Unit 2 advised she had slight neck
pain but was okay.
The driver of the 2015 Ford Transit WA/CPC9731, was identified by his WADL as Roymar A
Pardomo Linares DOB: 6/11/2003. Roymar advised he was driving north on Logan Ave N, and he
believed that Unit 2 was attempting to turn into LA Fitness, and this was when he collided with the
rear bumper of Unit 2. Roymar showed me minor damage to the front bumper of the Transit. There
was no airbag deployment and Roymar advised neither he nor his passenger were injured. I forgot to
identify the passenger.
A DOL check of Roymar showed that he was Not Licensed -Eligible and otherwise clear and valid.
The driver of the 2016 Cadillac SRX WA/BAK8176 was identified by her WADL as Imelda C Lubandi
DOB: 6/3/1956. Imelda said that she was slowing for a turning vehicle on Logan Ave N when Unit 1
struck her. She showed me minor damage to the driver side rear bumper/quarter panel of the
Cadillac. There was no airbag deployment in the Cadillac and Imelda advised she had slight pain in
her neck.
I competed Sector citation #5A0882638 for RCW 46.61.015 No Valid Operators License with Valid ID
and RCW 46.61.145.1 Following Too Closely for Roymar. This citation should be mailed to his DOL
address.
Both vehicles were drivable and able to leave the scene.
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 11/19/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG59039 CASE# ' 25-80002 DATE AND TIME 1 1/19/25 07:51
OF COLLISION
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