HomeMy WebLinkAbout25-9119 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-9119 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 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# ❑
CowsloN 10 - 1-- 2025 1956 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 5300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2062355663 0 7 30
6� LAST NAME SARWARY FIRSTNAME TAWOS MIDDLE K 1 1 2 31
INITIAL
STREET ❑ 14207 42ND AVE S APT 201 CITY TUKWILA ST WA Zjp, 981684181 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 10 1- 30 - 2000 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
10 7❑
LICENSE CHY9386 sTArI WAurN# WBA869G50HNU50603 3
PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2017 BMW 330 4D MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE J 9 34
DAMAGE YES NO
13 4 YES[:] No
REGISTERED OWNER INFO TAWOS SARWARY 1420742ND AVE S APT 201 TUKWILA WA 98168 D:2062355663 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO ALLSTATE 820895488 4
LI EFFECT I POLICY# TOPVE—LE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062508569
16 a
LAST NAME WILLIAMS FIRST NAME RAKISHA MIDDLE I S
INITIAL
17 STREET I❑ 1514 66TH ST SE CITY AUBURN ST WA ZIP 980928149 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE I WA ]SEX IF D.O.B. 01 23 _ 1978 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS BACK PAIN
❑ILICENSE 21❑ PLA E# AZK9562 TArE 41
WA VIN# 1N4AL3APOEN246524 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2014 MAKE NISS MODEL ALTIMA STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JASON WILLIAMS 151466TH STSE AUBURN WA 98092 D:4042749076 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO GEIC0445074948SIN 1 9TOP
VEHICLE CITATION# CHARGE
25❑ JAGENCY
i o BOTTOM
LEGALLY YES N�
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
ROBIN SMITH 12986 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG41689
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9119
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WILLIAMS JASON J
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1514 66TH ST SE AUBURN WA 980928149 4042749076 SEX M MMDOYyry 12 - 14 - 1973
PASSENGER Z WITNESS[:] UNIT# 2 Pas 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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.
ROBIN SMITH 10-22-25 03:31 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 10/26/2025 8:29:59 PM
BADGE OR ID# 9Y988 OR]# WA0171300 TIME POLICE DISPATCHED! 8:00 PM TIME POLICE ARRIVED',8:05 PM
FART I PAGE IT]OF 4�
REPORT NO. EG41689 CASE# 25-9119 OF COLLISION
10/21/25 19:56
OF CbLLI510N
NARRATIVE
25-9119
Unless otherwise stated, the following occurred in the City of Renton, County of King, State of
Washington.
On 10-21-2025 at approximately 1956 hours I was dispatched to an unknown if injuries collision that
occurred in the 5300 block of Talbot RD S. Upon arrival, I contacted the involved parties and
determined that the driver of Unit#2 was complaining of back pain, but declined to be evaluated by
the Renton Regional Fire Authority. While on scene, I collected the involved parties driving
documents and their independent recollection of events leading up to the collision.
The driver of Unit#1 was the sole occupants of his vehicle. He said he was traveling northbound in
the 5300 block of Talbot RD S when Unit#2 stopped in front of him, and he did not have enough time
to brake. The driver of Unit#1 collided with the rear of Unit#2, causing front end damage to Unit#1.
The driver of Unit#2 said she and her passenger were traveling in the 5300 block of Talbot RD S
when a street flagger associated to Sikh Temple signaled for her to stop driving in the roadway so
they could let other vehicles exit a parking lot from the west side of Talbot RD S. She obeyed the
traffic flagger and stopped her vehicle in the roadway. While she was stopped, the driver of Unit#1
rear ended her vehicle. Unit#1 sustained rear end damage.
I find the driver of Unit#1 to be the proximate cause of the collision because he was unable to stop
his vehicle before colliding with Unit#2. An exchange of information was provided to both drivers. I
took photos of the damaged vehicles and uploaded them to Axon. Both vehicles were able to drive
away from the scene.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by Robin Smith #12986 on 10/22/2025 @ 0323 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EG41689 CASE# 25-9119 DATE AND TIME 10/21/2519:56
OF COLLISION
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PAGE 4 OF 4