HomeMy WebLinkAbout26-2615 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG92759oc� RA
COLLISION REPORT 1591971
❑ El
�A$E 26-2615 2 0 5
INTERSTATE CITY STREET ✓STATE ROUTE OTHER LOCALAGENCY 4250 3
CODIN6COUNTY RD PRIVATE WAY
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 04 - 05 - 2026 0531 17 =.= S 8 W e OF IN e l070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e 17400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------ 1.1 FEET e S 8 W e SE CARR RD
0 3 29
MOTOR PEDAL- DAM AG TSHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO ✓ Q 1 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31
INITIAL
STREET F�
NEW ADDRESS CITY', RENTON ST: ZIP: 2
7� +COL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO✓ INTERLOCKVEs NO✓ YES NOW
8❑ LICIENSE# SRVERISTTATE SEX U MMDDYY' —=— 1 2 32
9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM
USEET 9 CLASSY 0 NATURE OF INJURIES 2
LICENSE 3
10 l I as ATF CWA9723 STATE WA vrN#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR TRLR 1 1 7 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2012 MAKE NISS MODEL ROGUE STYLE 4H VEHICLE TOWED[n TO ZBUN TOWED By GOVT VEHICLE 1 $ 34
13 DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO LURBIN PERDOMO VALLE 231758TH AVE E,APT H06 FIFE WA 98424 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
V""' CHARGE t S 36
LEGALLY YES❑NO❑ CITATION# t a 60TTOM
15❑ STM ING s 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM T OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO f/ D:4255479969
16�
LAST NAME ROMERO-JACOBO FIRST NAME BRAN MIDDLE A
INITIAL
17 F1 STREET ❑
❑ 12644 SE 169TH ST CITY'.. RENTON ST, yyq ZIP 98058 $ 37
NEW ADDRESS
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
CDL INTERLOCKYEs NO✓ INTERLOCK YES NO✓
YES NO✓
19[ DRIVER'S STATE WA SEX M D.O.B. 01 13 1992 39
'..LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 R U ET INJURY 1 NATURE OF INJURIES 40
21 LICENSE CAU5218 raTE WA vIN# 5FNRL5H23EB094563 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2014 MAKE HOND MODEL ODYSSEY STYLE VI1J VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO CARLOS ROMERO 12644 SE 169TH ST RENTON WA 98058 D:3234700213 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GEIC04407644238
IN EFFECT &POLICY#VEHICLE
t STOP
E—Y YES
LEGALL ❑ N.I—I, CITATION# CHARGE to BOTTOM
L
25 a
OFFICER'S NAME(PRINT)
26 OFFICER PHONE BADGE OR ID# --JAGENCY
P.LANTAGNE 12575 WA0171300
PART A PAGE 01 OF
3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG92759
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2615
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) ROMERO CARLOSA
ADDRESS&PHONE# D O
12644 SE 169TH ST RENTON WA 98058 3234700213 SEXi M MMDDYYYY 08 — 05 — 1998
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 3 2 4 1 USE CLASS ;1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY: 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
PC& I 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.
P.LANTAGNE 04-05-26 06:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 4/8/2026 4:07:01 AM
BADGE OR ID# 12575 ORI# WA0171300 TIME POLICE DISPATCHED 5:34 AM TIME POLICE ARRIVED i 5:45 AM
PAST B 3 Do-3mx—attar gt 1Mfft PAGE 2�OF 4
REPORT NO. EG92759 CASE# 26-2615 DATE OF COLLI r�510NN + 04/05/26 05:31
L1
NARRATIVE
26-2615
On 04/05/2026 at approximately 0531 hours, 1, Officer Lantagne, responded to a non-blocking, non-
injury collision which occurred at the intersection of 108th AVE SE and SE Carr RD, which is located
in the City of Renton, County of King, and the State of Washington. 1 responded in my fully marked
police vehicle, wearing my patrol uniform.
I contacted the driver of Unit#2, Brian Romero-Jacobo (DOB 01/13/1992) in the parking lot of Valley
Medical Center. Romero-Jacobo told me the following: Romero-Jacobo was driving southbound in
the right curb lane of 108th AVE SE and was stopped at the intersection at SE Carr RD. As Romero-
Jacobo started to drive through the intersection going southbound, the vehicle to his left merged into
his lane and struck the left rear wheel and quarter panel of Romero-Jacobo's vehicle.
The vehicle kept driving west on SE Carr RD and Romero-Jacobo attempted to follow it. Romero-
Jacobo was able to locate Unit#1, a white Nissan Rogue with license plates CWA9723 issued out of
Washington State, at the intersection of S Carr RD and Talbot RD S. Romero-Jacobo thought the
vehicle was going to stop but it took off and he lost sight of it.
I observed the damage to Romero-Jacobo's vehicle which consisted of scrapes and white paint
transfer on the left rear of his vehicle. The damage was consistent with his statements.
I conducted a Department of Licensing check using the license plate provided by Romero-Jacobo
which returned to a 2012 Nissan Rogue registered to Lurbin U. Perdomo-Valle (DOB 09/02/2002) out
of Tacoma. Perdomo-Valle did not have a valid driver's license out of Washington State, was
previously cited for operating a motor vehicle without insurance, and had an active warrant, warrant
4A0271930, out of Fife for DV assault in the 4th degree with a bail amount of$5,000.
1 advised Romero-Jacobo of my findings and provided him with an exchange of information. Romero-
Jacobo stated he did not see the driver of Unit#1 due to the tinted windows.
The collision diagram is an accurate illustration of the events leading up to the collision.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0640 hours on 04/05/2026 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EG92759 CASE# 26-2615 DATE AND TIME 04/05/2605:31
OF COLLISION
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