HomeMy WebLinkAbout25-7135 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG19820oc� RA
COLLISION REPORT 1591971
CASE# 25-7135 2
INTERSTATE CITY STREET FIRE I
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAI-A`NG 4200 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 o v' 08 - IN
15 - 2025 1542 17 �.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION �✓
TALBOT RD S BLOCK NO. e 1000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8 W e S GRADYWAY
0 1 29
MOTOR ✓ PEDAL- F DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES NO ✓ D:2066099071 Q 1 30
6❑ LAST NAME ARROYO ZAMORA FIRST NAME HECTOR MIDDLE M 1 2 31
INITIAL
STREET Q 10415 65TH AVE S
NEW ADDRESS CITY I $EATTLE ST: WA ZIP: 981782506 2
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYEs NO YES NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 03 — 04 — 2005 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 9 EJECT 1 N USEET INJUR
CLASSY 14 1
NATURE of INJURIES 2
LICENSE, CPU6373 STATE WA V(N#; 3N1AB61E98L673673 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM To
TRLR zRLR. 5 1 33
12 0 Q VIN#' VIN#
FROM TO
VEH.YEAR 2008 MAKE NISS MODEL SENTRA STYLE P4 VEHICLE TOWED fj TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13 DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE INSURANCE CO 14 DAfRY LAND 11410176183
IN EFFECT &POLICY#V""' CHARGE 36
LEGALLY YES❑NO❑ CITATION# <14,
15 STANDING
MOTOR ✓ PEDAL- PEDESTRIAN1:1 PROPERTYEl DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES NO �/ D:2063273197
16�
LAST NAME MOHAMED FIRST NAME MONA MIDDLE' A
INITIAL
17F1 SS
STREET ❑ 37
NEW ADORE 26257 125TH PL SE CITY' KENT ST, WA ZIP 980307976
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES No INTERLOCKYEs NO vEs No
19 DRIVE # STATE SEX F MD.02, 07 12 2003 39
LICENSE :
20❑ ON DUTY STATUS AIRBAG 2 RESTR g EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS 1 ❑
21 LICENSE CBF5160 TATe WA VIN# 5NPLN4AGONHO56371 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE HYUN MODEL ELANTRA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ NO✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
NQ.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE 8203273197
IN EFFECT &POLICY# t STOP
VEHICLE
❑ ,J—I CITATION# CHARGE to BOTTOM
EEGnEEY YES N`,LI
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SULIASI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG19820
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7135
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&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
On 08/15/2025, at approximately 1342 hours, I was dispatched to an accident on TALBOT RD S/S
GRADY WAY, in the City of Renton, while I was employed as a uniformed Patrol officer for the City of
Renton, County of King, State of Washington.
I spoke with the driver of Unit#1, and he advised that he was on Talbot Road South, traveling
northbound, in lane #1 (lane #1 being near the curb). Unit#1 stated there was another vehicle
between him and Unit#2. As he continued traveling northbound, the vehicle in front of him suddenly
turned, prompting him to apply his brakes. However, due to the rainy weather and wet road
conditions, he was unable to stop. This caused his vehicle to collide with the rear of Unit#2, resulting
in damage to his front bumper.
spoke with the driver of Unit#2, and she advised that she was on Talbot Road South, traveling
northbound, in lane #1 (lane #1 being near the curb). She stated that traffic had come to a stop, and
while she was stopped, she was hit from the rear of her vehicle by Unit#1. Unit#2 had damage to the
rear bumper of the vehicle.
Both vehicles were drivable, and the driver claimed no injuries. Exchange of information was provided
to both drivers.
Photos were taken and uploaded as evidence.
This concludes my report.
My Axon camera was on for this call.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct. This report was electronically signed by Officer S. Tamaivena #12788,
August 16th, 2025, at 0554, Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SULIASI TAMAIVENA 08-16-25 05:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVEQ BY DATE
S.WOODWARD 11528 811712025 12:37:59 PM
BADGE OR ID# 12788 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:50 PM TIME POLICE ARRIVED i 3:50 PM
PAST B 3 Da-lmx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG 19820 CASE# 25-7135 DATE AND TIME 08/15/25 15:42
OF COLLISION
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