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HomeMy WebLinkAbout25-80473 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG62823OLCERA COLLISION REPORT 1591971 CASE# 25-80473 2 INTERSTATE CITY STREET FIRE I RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s on' 12 - 07 - 2025 1659 17 =.[� S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. e .� 4a PARKAVEN MILE POST ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e N 3RD ST 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533260902 0 1 30 5 LAST NAME PORTELA LOPEZ FIRST NAME RAQUEL MIDDLE N 1 1 2 31 INITIAL STREET ] 662 SHELTON AVE NE CITY; RENTON ST I WA ZIP; 98059 2 NEW ADDRESS 7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YEs No✓ INTERLOCKVEs Na✓ YES NO✓ 8 DRIVER # STATE WA SEXI F MMDDYY' 07 - 10 - 1986 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, CFW3543 STATE WA VIN#; 1FMYU93116KC43602 3 10 Fl I as ATP rt TRAILER 11 3 5 STATE TRAILER STATE PLATE# PLATE# ROM To TRLR zRLR 1 3 33 12 3 5 VIN# vIN# FROM TO 13 4 VEH.YEAR2006 MAKE FORD MODEL ESCAPE STYLE UT VEHICLE TOYED NO�iS46LIN T�VyED.6LRS GES❑END 5 1 34 DAMAGE IIII._IIII HHttVVii((tt REGISTERED OWNER INFO GUADALUPE REYES REYES 662 SHELTON AVE NE RENTON WA 98056 VEHICLE NO. 1 SHADE IN DAMAGED AREA 11 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 4 IN EFFECT &POLICY# 9TOP V""' CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# t a BOTTOM 15❑ STM ING s 7 6 11 MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR D:2063008146 16� LAST NAME LEE FIRST NAME REBECCA MIDDLE' A INITIAL STREET ❑ 37 17 ❑ 6316 129TH PL SE CITY' BELLEVUE ST, yyq ZIP 980064045 4 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs NO✓ INTERLOCK YES NO✓ vEs NO✓ 19 DRIVER'S STATE WA SEx F DOB 09 12 1976 � 39 LICENSE# MMbDYY - 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 7 HELMET 2 INJURY NATURE OF INJURIES 40 USE CLASS PAIN AND BRUISES ON SHINS 21 LICENSLATE E CCN3690 raTE WA vIN# 5TDEBRCH7NS083632 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# TOWED BY GOV HI 44 VEH.YEAR 2022 MAKE TOYT MODEL H/GHlAN STYLE UT VEHICLE TOWED✓ No BLIN BANKERS ves No✓ 24 REGISTERED OWNER INFO SCOTT WONG 6316129TH PL SE BELLEVUE WA 98006 VEHICLE NQ.2 SHADFjy DA GED AREA 4 LIABILITY INSURANCE INSURANCE CO ALL STATE 976284053 IN EFFECT &POLICY# 9TOP VEHICLE ❑ ,J—I CITATION# CHARGE tO BOTTOM HE YES N 6 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEVIN PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG62823 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80473 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) REYES JADE R ADDRESS&PHONE N, 662 SHELTON AVE NE RENTON WA 98059 SEXi F MMDDD B. 12 - 04 - 2021 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES 1 POS. 9 6 10 1 USE 2 CLASS 1 ----� :NAME Lnsr EIRST,MIDDLE INITIAL) WONG CONNOR J ADDRESS R PHONE* 6316 129TH PL SE BELLEVUE WA 98006 SEX' M D O,e• 07 _ 15 _ 2013 MMDDYYYY SEAT HELMET INJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. ' 7 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� NAME MIDDLE INITIAL) WONG KADEN S (LAST,FIRST, AQQREss a PHONE# 6316 129TH PL SE BELLEVUE WA 98006 SEXM D.0.8. 04 _ 12 _ 2010 MMDDYYYY PASSENGER WITNESS UNIT# 2 SEAT 1 9 AIRBAG 6 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 E OF INJURIES a NATUR POS. USE CLASS NARRATIVE' I was dispatched to a vehicle collision on 12/07/25 at Park Ave N and N 3rd St, in city Renton, King County WA. Unit 1CFW3543 Driver: Raquel N. Portela-Lopez (DOB 07/10/1986) Unit 2 CCN3690 Driver: Rebecca A. Lee (DOB 09/12/1976) Upon arriving I spoke to driver of Unit 2 who told me that she was traveling in lane 2 heading North on Park Ave N. As she was approaching the intersection of N 3rd St the driver of Unit 1 turned left Infront of her and she crashed into Unit 1. Unit 2 stated she had a green light as well. She told me that she had bruises on her shins and her husband had knee pain on the left knee. Children had no injuries. I then spoke to the driver of Unit 1 who told me they were traveling South on Park Ave N. When they approached the intersection of N 3rd St and attempted to turn left, they were then hit by Unit 2. Unit 1 stated they had a green light to turn. She told me that there were no injuries to either her or the baby. Renton Fire arrived on scene to evaluate all personal. Information Exchange was given to both parties. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 12/08/2025, 0028 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 12-08-25 02:00 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 1212612025 12:22:53 AM BADGE OR ID# ( 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:59 PM TIME POLICE ARRIVED i 5:06 PM PART B a Da-3mx-attar gt 1Mffp PAGE F2 --]OF 4 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG62823 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80473 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) WONG SCOTT D ADDRESS&PHONE# 6316 129TH PL SE BELLEVUE WA 980064045 SEXi M MMDDD B. 12 — 12 — 1973 SEAT HELMET INJURY INATURE OF INJURIES PASSENGER z WITNESS El UNIT# 2 POS. 3 AIRBAG j 6 RESTR. 4 EJECT 1 USE 1 2 CLASS 7 LEFT KNEE PAIN :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS R PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE I was dispatched to a vehicle collision on 12/07/25 at Park Ave N and N 3rd St, in city Renton, King County WA. Unit 1CFW3543 Driver: Raquel N. Portela-Lopez (DOB 07/10/1986) Unit 2 CCN3690 Driver: Rebecca A. Lee (DOB 09/12/1976) Upon arriving I spoke to driver of Unit 2 who told me that she was traveling in lane 2 heading North on Park Ave N. As she was approaching the intersection of N 3rd St the driver of Unit 1 turned left Infront of her and she crashed into Unit 1. Unit 2 stated she had a green light as well. She told me that she had bruises on her shins and her husband had knee pain on the left knee. Children had no injuries. I then spoke to the driver of Unit 1 who told me they were traveling South on Park Ave N. When they approached the intersection of N 3rd St and attempted to turn left, they were then hit by Unit 2. Unit 1 stated they had a green light to turn. She told me that there were no injuries to either her or the baby. Renton Fire arrived on scene to evaluate all personal. Information Exchange was given to both parties. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 12/08/2025, 0028 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 12-08-25 02:00 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 12/26/2025 12:22:53 AM BADGE OR ID# ( 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:59 PM TIME POLICE ARRIVED i 5:06 PM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 3�OF 4 REPORT NO. EG62823 CASE# 25-80473 DATE AND TIME 12/07/2516:59 OF COLLISION 1' }It tM4, i 4 �tZ a lF) l psi 4, r� PAGE 4 OF 4