HomeMy WebLinkAbout25-81166 TFF' NoucERA II I !�� I III I III I IIII III II I O 3 27c .
COLLISION REP FIT 1591971
CASE 25-81166 z
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 TOTAL#pF OBJECT 1 F
1 8 28
TRIBAL UNITS OZ
RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 12 - 1-- 2025 1813 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e S GRADYWAY
0 8 29
UNIT 01 MOTOOR � PED
AL ❑ YESAGE NHORE✓LDMET PHONE 0 1 30
6� LAST NAME PEREZ FIRSTNAME HENRY MIDDLE D 1 2 31
INITIAL
STREET ❑ 19932 97TH AVE S CITy RENTON ST WA ZIP 980556227 z
NEW ADDRESS
7❑ CDL 1/ I IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 02 - 03 - 1980 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASSY 5 [NATURE OF INJURIES
UNK POSSIBLE STROKE z❑
3
10[1 P1 ATE 14 BKX9117 sTAT WAv N#' 2T2HK31 U18C054128
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom To
TRLR. TRLR 9 9 33
12 3 5 vIN#' vIN#
FROM TO
❑ VEH.YEAR 2008 LEXS RX 300 SV MAKE MODEL STYLE VEHICLE TOWED TO BLIN Tg YMEYERS GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No YES[:] No
REGISTERED OWNER INFO DENISE PEREZ 1993297TH AVE S RENTON WA 980556227 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 36
LEGALLY YES❑NO 21
CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062183861
16 a
LAST NAME YIN FIRST NAME CHERIE MIDDLE R
INITIAL
17 STREET❑ NEW ADOREss❑' 4175 S 131ST ST CITY''' TUKWILA ST WA ZIP 98168 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 07 15 _ 1970 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CUS4378 TATE 41
WA vIN# 7SAYGDEE9TF443248 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GoI
VEH —VEHICLE
YEAR 2026 MAKE TESL MODEL MODE!Y STYLE $V AMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DA GEbAREA
LIABILITY
INSURANCE &POLICY#E CO TRAVELERSIN 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25 s e
=RSE
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12994 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO.
COLLISION REPORT III III III III III 111
1591972 CASE# 25-81166
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
POS. 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.
JAMAAL KEARSE 12-31-25 01:00 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 12/31/2025 9:54:49 AM
BADGE OR ID# 12994 OR]# WA0171300 TIME POLICE DISPATCHED', 6:15 PM TIME POLICE ARRIVED',6:17 PM
PART I PAGE IT]OF 4�
REPORT NO. CASE# 25-81166 OF COLLISION
12/30/25 18:13
OF CbLLI510N
NARRATIVE
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 12/30/2025, at approximately 1814 hours I was dispatched to a report of a welfare check at the
intersection of Rainier Ave S and S Grady St. Dispatch advised in the intersection an older male was
passed out behind the wheel of a silver Lexus SUV. The male was not responding to RP knocking on
the window. Dispatch later advised a new RP called in stating the silver Lexus SUV hit her vehicle.
At approximately 1817 hours I arrived on scene. Observed Unit 1, a silver 2008 Lexus (WA LIC
BKZ9117) in the southbound lane facing northbound. I pulled in front of the vehicle to pin it in from the
front. I observed the Driver of the silver Lexus with his head back and eyes closed. The driver was
later identified as Henry D. Perez DOB 2/3/1980. Henry was unresponsive and appeared to be
unconscious with agonal breathing. Officer Ediger and myself broke the driver side window and
pulled Henry out of the car. Henry's eyes were pinpoint. Henry was in fact unconscious with agonal
breathing. Officer Ediger and myself began rendering aid until Renton Fire and Medic One arrived.
Renton Fire and Medics took over aid. According to Medics, Henry was showing signs of a possible
stroke or a medical condition.
The driver of Unit 2 advised the following information. She was northbound on 167 and stopped at the
red light of S Grady Way. She was in lane 4 of 4 preparing to turn westbound onto S Grady Way. Unit
1 was also traveling northbound on 167 in lane 3 of 4. Unit 1 side swiped the passenger side of Unit
2. Unit 1 continued to slowly roll through the intersection until it stopped in the southbound lanes of
Rainier Ave S. The driver of Unit advised she has travelers insurance but could not find her policy
number. She advised she was able to speak to her insurance agent and would have the information
tomorrow.
I was unable to speak to the driver of Unit 1. He was transported to Harbor View Medical Center.
Officer Swan was able to speak to one of Henry's daughters. Please see his Supplemental report for
more information.
Officer Dougherty and Ediger took photos and uploaded them into evidence.com.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer J. Kearse #12994 12/30/2025 2156 Hours Renton, King County,
Washington
PAGE 3 OF 4
REPORT NO. CASE# '' 25-81166 DATE AND TIME 12/30/25 18:13
OF COLLISION
U
z
1
4 '
r as
2�
C
y�Y3
m.
t q #
A
1
d
Y�
z
x.�
a
A
z
s`
ii
PAGE 4 OF 4