HomeMy WebLinkAbout26-235 TFF' NoucERA II I !�� I III I III I IIII III II I O 5 27c .
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE#
26-235 z
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#(3F OBJECT 1 F
1 4 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# 1 7
GawsloN 01 - 09 - 2026 0344 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S GRADY WAY BLOCK NO. e✓ 301
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 FMILES EET e S ❑ E e RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2147186400 30
LAST NAME GOPALAKRISHNAN FIRST NAME DEVIPRAKASH MIDDLE A
6 INITIAL 1 2 31
STREET ❑, 13561 ROOSEVELT WAY N CITY SEATTLE ST WA ZIP 981337861 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YEs No✓
8❑ DRIVERS
# STATE WA SEX'M I D-MMDDYY' 01 — 02 — 1987 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE
CNR6282 sTAr1 WAvIN#' JN86T3B68PW462219
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13FAl 2023 NISS ROGUE SD DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO SECURITY SERVICES NORTHWEST 250 CENTER PKWY SEQUIM WA 98382 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE INSURANCE CO RISK SURE CPP1311935 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe 1 5 36
LEGALLv res NO CITATION# CHARGE BOTTOM
15❑ ...... 8 6
UNIT U2 VEHICCMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME ELlIS FIRST NAME DERRICK MIDDLE D
INITIAL
17 STREET I❑ s❑' 34709 9TH AVE S A 200 CITY FEDERAL WAY ST WA ZIP 98003 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LDI IVER # STATE WA SEX M M D.O.B. 07 20 _ 1999 39
20 ON DUTY STATUS 0 AIRBAG RESTR EJECT I WEB MEET 2 LASSY 6 ABRASIONS TO BODY,BACK/NECK PAIN NATURE OF INJURIES 40
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 1 5 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=ON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12421 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO.
COLLISION REPORT III III III III III 111
1591972 CASE# 26-235
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.
D.NELSON 01-09-26 01:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 111412026 8:45:19 AM
BADGE OR ID# 12421 OR]# WA0171300 TIME POLICE DISPATCHED 3:45 AM TIME POLICE ARRIVED 3:46 AM
PART I PAGE IT]OF 4�
REPORT NO. CASE# 26-235 OF COLLISION
01/09/26 03:44
OF CbLLI510N
NARRATIVE
26-235 ACCINJ
On 1/9/2026 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I added myself to a dispatched call of a vehicle versus pedestrian collision that had
occurred in the parking lot of 301 S Grady Way Renton/King/WA. The driver of the involved vehicle
was calling to report that he had struck someone in the parking lot.
RRFA was dispatched to the scene, they arrived prior to my arrival and had extricated the victim from
underneath Vehicle 1.
Initial responding Officers arrived on scene and began Standardized Field Sobriety Tests' (SFST) on
the driver. The concluded that the driver did not show any sign of impairment. He was given a PBT on
scene which gave a reading of 0.0.
The driver of the 2023 Nissan Rogue WA/CNR6282 was identified by his WADL as Deviprakash
(Dev) Gopalarkrishnan DOB: 1/2/1987. Dev said that he was pulling into the northern most gas pump
at the location from the west, he said that he was looking over his right shoulder to try and line his gas
cap up with the pump. He said that as he was pulling forward to the pump, he felt the bump, he then
began to back up realizing he hit something and then heard the screaming. He then called 9-1-1.
There was no damage to the Nissan.
The victim was identified as Derrick D Ellis DOB: 7/20/1999, Derrick was heavily intoxicated by an
unknown substance and gave minimal information to responding Officers. Derrick was being treated
in the ambulance for complaint of paint to his right hip, left mid-back, and right lower back. I was able
to see abrasions to his head and both his knees. RRFA advised they did not know the extent of the
injuries and would take him to VMC for further evaluation. Derrick was alert and conscious.
Responding Officers reviewed surveillance footage that showed that Derrick was lying in the roadway
directly in front of the gas pump for approximately 1-hour before Dev pulled up. It appeared as if he
was covered by a blanket or dark clothing.
This surveillance footage was uploaded to Axon Evidence.
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 1/9/2026 Renton WA
PAGE 3 OF 4
REPORT NO. CASE# + 26-235 DATE AND TIME 01/09/26 03:44
OF COLLISION
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