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Home My WebLink About23-9083 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-9083 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# cawsloN 08 - 08 - 2023 0813 17 . N E IN� S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e✓ 500 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e S 4TH PL 0 6 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO ✓ D:2067028617 0 81 30 6 LAST NAME AREVALOS MARTINEZ FIRSTNAME LUIS MIDDLE O 1 1 2 31 INITIAL STREET ❑ 2426 S 370TH PL APT 70 CITy FEDERAL WAY ST I WA 2jp, 980037660 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� C21605U sTArI WAvIN# 1FD8X3G61FED08702 ----� TRAILER 03574AJ STATE WA TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro rRLR - TRLR 5 1 33 12 3 5 vIN#' 16VNX1620J2015429 YIN If FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 9 34 13 4 2015 FORD F350 DAMAGE YES NO ✓ YES[:] NO✓ REGISTERED OWNER INFO MONARCH LANDSCAPING 9000 EXECUTIVE PARK DR STE A I KNOXVILLE TN37923 D:2067028617 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO LIBERTY MUTUAL AS2661067138023 3 4 IN EFFECT &POLICY# 9TOP VEHICLE 5 36 LEGALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 8 7 6 MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ✓ D:4254954482 LAST NAME DEVEREUX FIRST NAME JAMES MIDDLE G INITIAL 17 STREET I❑ s❑' 14406 1 4❑48TH PL SE CITY' RENTON ST WA ZIP 980597332 37 NEW ADOREs 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INERLOCKYEs❑No� INTERLOCK ves No� YEs NDF 19 LDICENS STATE WA SEX M M .C... 11 � 26 _ 1957 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ILICENSE 21❑ PLA E# AKL7179 TArE 41 WA vIN# JTDK820U493468990 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' VEH YEAR 2009 MAKE TOYT MODEL PRIUS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO JAMES DEVEREUX 14406148TH PL SE RENTON WA 98059 D:4254954482 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO GEIC04288-87-27-59IN 1 GQO, VEHICLE CITATION# CHARGE LEGA YES[Z N(� 25❑ LLY s a 7p-, S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 TAGNE 12575 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED88498 COLLISION REPORT III III III III III 111 1591972 CASE# 23-9083 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 PM 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. P.LANTAGNE 08-08-23 06:28 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 811212023 9:32:03 AM BADGE OR ID# 12575 OR]# WA0171300 TIME POLICE DISPATCHED 8:21 AM TIME POLICE ARRIVED i 8:21 AM PART I PAGE IT]OF 4� REPORT NO. ED88498 CASE# 23-9083 OF COLLISION 08/08/23 08:13 OF CbLLI510N NARRATIVE 23-9083 On 08/08/2023 at approximately 0813 hours, I, Officer Lantagne, responded to a non-blocking, non- injury collision near the intersection of Rainier AVE S and S 4th PL, which is located in the City of Renton, County of King, and the State of Washington. I responded in my fully marked police vehicle, wearing my patrol uniform. I arrived on scene and observed Unit#1, a 2015 Ford F350 with license plates C21605U issued out of Washington State, and Unit#2, a 2009 Toyota Prius with license plates AKL7179, parked in the McLendon's parking lot. I was advised there were no injuries, however, the driver of Unit#2 was lightheaded and dizzy. I contacted the driver of Unit#1, Luis O. Arevalos-Martinez (DOB 04/26/1982), who told me the following: Arevalos-Martinez was driving northbound on Rainier AVE S. As Arevalos-Martinez approached the intersection at S 4th PL, the signal was red and Arevalos-Martinez attempted to stop. Arevalos-Martinez's foot slipped off of the brake pedal and the front of his vehicle struck Unit#2, which was stopped at the red light. I contacted the driver of Unit#2, James G. Devereux (DOB 11/26/1957), who told me the following: Devereux was in a northbound lane of Rainier AVE S at the intersection of S 4th PL. Devereux was stopped for a red light. While Devereux was waiting for the light to turn green, the rear of his vehicle was struck by Unit#1. I observed the damage to the vehicles and other physical evidence was consistent with the statements made by both drivers. Unit#1 had minor scrapes on the front tow hooks. Unit#2 had two holes cracked in the rear bumper which matched the tow hooks from Unit#1, along with other scrapes. The collision diagram is an accurate illustration of the events leading up to the collision. I provided an exchange of information to Arevalos-Martinez and Devereux. 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 1813 hours on 08/08/2023 at Renton, WA. PAGE 3 OF 4 REPORT NO. ED88498 CASE# ' 23-9083 DATE AND TIME 08/08/23 08:13 OF COLLISION S'4th Pl Case #23-9083 Not to Scale P. Lantagne #12575 Unit#2 Unit#1 Rainier Ave S PAGE 4 OF 4