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
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PAGE 4 OF 4