HomeMy WebLinkAbout25-9056 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG40968oc� RA
COLLISION REPORT 1591971
CASE# 25-9056 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LDCCOAGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 03 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
ear soe' 10 - 20 - 2025 0616 17 =.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLO4050 MAPLE VALLEY HW MILE POST
e 3600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e✓ SE 11TH ST
2 0 29
MOTOR ✓ PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES �/No D:2066189385 0 1 30
5❑ LAST NAME SOETAERT FIRST NAME HOLLY MIDDLE A 1 2 31
INITIAL
STREET ❑ 3316 SE 6TH ST CITY RENTON ST WA ZIP' 980582812 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKVEs NO YES NO
8 DRIVER # STATE WA SEXI F MMDDYY' 09 _ 10 - 1954 1 2 32
9 ON DUTY STATUS' AIRBAG 3 RESTR 9 EJECT 1 HELMET INJURY 7 ANKLE A INJURIES 2
USE CLASS ANKLE AND KNEE
10 LI ENSE' AFK0638 STATE WA VIN# 1GNKVJED7BJ396377 3
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR TRLR 7 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR ZOII MAKE CHEV MODEL TRAVER STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO HOLLY SOETAERT 3316 SE 6TH ST RENTON WA 98058 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE NSURANCE CO
14 Z FARMERS INSURANCE
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 36
Lemur yes[:]NO[:] CITATION# t a 80TFOM
15❑ sTANowc
MOTCSR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2062932642
16�
LAST NAME LEWIS FIRST NAME ROYAL MIDDLE S
INITIAL
17 F1 STREET ❑❑ 5403 LAKEMONT BLVD SE APT 112 CITY BELLEVUE ST, yyq ZIP 980066608 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOGKYES No JNTERLOGKYES No YEs NO
19 DRIVERS STATE WA SEX I M D.O.s, 10 25 1990 � 39
LICENSE# MMDDYY
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 3 RESTR 9 EJECT 1 7 ❑
USE CLASS SCRATCHES ON FACE
21 LICENSLATE# BTN9712 TATE WA VIN# 1N4AL3AP1FC261076 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2015 MAKE ICI$$ MODEL ALTIMA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO ROYAL LEWIS 5403 LAKEMONT BLVD SE APT 112 BELLEVUE WA 98006 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
vewae ❑ ,J—I CITATION# CHARGE t080TTOM
EEGAEEY YES N 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SULIASI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG40968
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9056
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) WALLICK SAMUEL L
ADDRESS&PHONE# D�
16041 SE 170TH CT RENTON WA 98058 2066790995 SEXi M MMDDYYYY 12 — 10 — 1982
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�; POS. USE '.CLASS � ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL}
ADDRESS R PHONE#
SEX MMDDYYYY D.O.B. —
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES
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
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.
SULIASI TAMAIVENA 10-20-25 11:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1012412025 5:26:46 AM
BADGE OR ID# 12788 ORI# WA0171300 TIME POLICE DISPATCHED 6:21 AM TIME POLICE ARRIVED i 6:24 AM
PAST B 3 Do-lmx—attar(t 1Mff) PAGE 2�OF F6
REPORT NO. EG40968 CASE# 25-9056 OATS OF COLLI r�510NN + 10/20/25 06:16
L1
NARRATIVE
On 10/20/2025, at approximately 0616 hours, I was dispatched to an injury accident at 3600 block of
MAPLE VALLEY HWY, 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.
Upon arrival, I observed Units #1's vehicle in lane #2 on the opposite side of traffic facing eastbound
on Maple Valley HWY. In front Units #1's vehicle was Unit#2 who was on the correct travel of traffic
facing eastbound. Both of this vehicle had collided with each other as both front bumpers were facing
each other. Behind Unit#2 vehicle was Unit #3 who's in lane #1 with the vehicle partially on the
sidewalk. All vehicles looked to be heavily damaged.
Driver of Unit#1 advised she was in lane #1 traveling eastbound on Maple Valley HWY. She advised
she changed lane into lane #1 when she observed another vehicle driving head on. Driver said she
was unable to stop and collided with Unit#2. Driver did have two dogs with her in the back seat of
her. Animal Control was on scene and released the dogs to friend/family of the driver. Dogs did have
serious injuries and are being taken to Blue Peral for further evaluation. The driver did sustained
injuries to her ankle and knee. However, she did have very puffy and swelling to both her eyes. Both
eyes were bruised and advised that those injuries occurred yesterday from falling on her face.
Driver's vehicle was towed by Bankers as it was unable to drive and heavily damaged. Officers
weren't able to do nystagmus or SFST due to her eyes being swollen and her needing medical
attention. Although we looked for other signs of impairment, we weren't able establish any evidence.
Driver was transported to Valley Medical and provided with an exchange of information form.
Insurance name was provided but unable to locate policy number.
Driver of Unit#2 advised he was in lane #2 traveling westbound on Maple Valley HWY. He said he
was driving going 30-35 miles per hours behind a vehicle traveling in the same lane and direction.
Driver stated while driving, the vehicle in front of him, swerved into lane #1 with no pre indicators. At
this point, he said he then saw Unit#1's vehicle going head on with his which caused the accident.
He said he saw the vehicle the very last second and was unable to react. This driver sustained
scratched to the face but advised minor injuries. Vehicle was heavily damaged and unable to drive.
Bankers towed the vehicle as it was blocking the roadway and unable to drive. Driver was transported
to Valley Medical for further evaluation. I later went to Valley and provided his paperwork, I.D, and
exchange of information for him. He was not in the room but his fiance, Liz was and I provided her
with his paperwork. I asked Liz if Unit#2 had insurance for the vehicle and she was unsure if he did
or not. I provided my number and advised if he did to contact me.
The driver of Unit#2 also had a firearm in his backpack. Driver stated he had a valid CPL which he
did. The gun was described as a black colored Stoeger STR-9C 9mil (serial number
#T642921 S02622). Gun returned cleared and registered to the driver. The gun was taken into
evidence for safe keeping. Liz was informed on how to retrieve the firearm from Renton PD.
I spoke with driver of Unit#3, who advised he was also traveling westbound but in lane #1. He
advised he witnessed the accident and how it occurred. Unit#1 was in their lane #2 traveling
eastbound with Unit#2 was also in the same lane traveling westbound. He watched both vehicles
crash head on. He said as they collided Unit#2 vehicle made a sudden turn into his lane, possible
trying to avoid the accident last minute, which caused Unit#2's vehicle to also collide with his vehicle.
Unit#3's vehicle was damaged and unable to drive. It was towed by Bankers. Driver did not claim he
was injured at the time. Unknown if he will later be medically checked as he was in a hurry to work.
He was also provided with an exchange of information form. This driver did provide insurance with a
policy number and phone number, but his information somehow got lost in the system.
Finally, I spoke with a witness who saw partially of the accident. Samuel stated he was one car
behind unit#3 and only saw Unit#3 vehicle swerve right into the sidewalk but did not see what
caused it.
The approximate caused of the accident is Unit#1 as she was in Lane #2 on the opposite side of
traffic traveling eastbound. Also, with Unit#3 witnessing her in their lane of traffic before colliding with
Unit#2.
It should be noted that lane #1 is the nearest to the curb.
PAGE 3 OF 6
REPORT NO. EG40968 CASE# 25-9056 DATE OF COLLI r�510NN + 10/20/25 06:16
L1
NARRATIVE
Photos were taken on scene and submitted as evidence.
This concludes my involvement.
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,
October 20, 2025, at 1052, Renton, WA.
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. EG40968
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE# 25-9056
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY:
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # PLACARD
GWVR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE ( CYCLE ❑ PEDESTRIAN OWNER ❑'. YES NO
0 1 29
FIRST NAME MIDDLE'.
LAST NAME LUCHITA PETRU INITIAL
STREET 30
❑ NEW ADDRF 24826164TH AVE SE cirY COVINGTON I ST WA ZIP 980425232
6 PRESENT MEDICALTANSPORTED. 1 1 2 31
CDL A- REQUIRED 'IGNITION
INTERLOCK YES D NO INTERLOCK YES Nt3 YES NOf
L
DRIVER'S D.O.B
7
LICENSE WA SEX M MMDDB 04 - 04 - 1995
ON DUTY STATUS AIRBAG 3 RESTR. 9 EJECT 9 HELMET INJURY 1 NAruREofINJURIEs
USE :CLASS
8 ❑ : 1 32
LICENSE'D69978C TAT WA VIN W1Y8KC3Y7PT144388
PLATE#
9 TRAILER TRAILER L
PLATE# STATE PLATE# STATE
0
10 ❑ TRLR TRLR
VIN# VIN#.
11 0 0 VEH.YEAR2023 MAKE MERZ MODELSPRINTE STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VEHICI E FROM TO
DAMAGE YES NO ✓ YES NO
tLC PETRU'S STUCCO AND MASONRY 24826 164TH AVE SE COVINGTON WA 98042 3 7 33
REGISTERED OWNER INFO. SHADE IN DAMAGED AREA
12
4 FROM TO
INSURANCE CO
LIABILITY INSURANCE PROGRESSIVE 5
❑ IN EFFECT O &POLICY# 5Tt7P m 34
13 A vEnic�E YES NO CITATION# CHARGE 1E2801 TOM
ecauv
sTnNoiNc (� 7 v
MOTOR PEDAL_ ' PROPERTY : DAMAGETHRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET CITY ST' ZIP
NEW ADDRESS"
CDL IONI7ION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED.
INTERLOCK YES NO INTERLOCK YES NO YES NO: ❑
17 37
LIRIVERSICENSE# SEX MM
L STATE DDB _� C----�
❑
HELMET '.INJURY: NATURE OF INJURIES 38
18
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS.
19 ❑ ❑ 39
LICENSE TAT vIN#
PLATE#
20 TRAILER I TRAILER 40
PLATE#, STATE PLATE# - STATE ❑
21 ❑ TRLR TRLR 41
VIN#�, VIN#Y
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE
INSURANCE CO
IN EFFECT &POLICY#
3 44
CITATION# CHARGE 024 sTA LyYES❑ K-99
F__ B 7 G
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SULIASI TAMAIVENA 10-20-25 11:39 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12788 O#RI WA0171300 APWOODtNARD 10%24/202 PAGE OFF
3000-345-013(R 11/18)
REPORT NO. EG40968 CASE# 25-9056 DATE AND TIME 10/20/25 06:16
OF COLLISION
4
e
{
y
� � t
tot
jt:fir
l
PAGE 6 OF e