HomeMy WebLinkAbout26-101 II III III IIIII IIII III II I SUPPLEMENTAL
O EG66136 t 27iiT REPORT
COLLISION REPORT 1591971
❑ 0✓ RESULTED ❑ CASE#I 26-101 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAI-AGENCY 4200 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#
DATE OF N E
eDLLISION' 01 - 05 - 2026 0713 17 =.= S 8 W E OF IN M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE SUNSET BLVD BLOCK ST e 1500 .=
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e✓ S 8 W e✓ `�NACORTES AVE NE
OF11
29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2069465882 0 1 30
5❑ LAST NAME BOONE FIRST NAME AUSTIN MIDDLE S 1 2 31
INITIAL
STREET ❑ 29720 45TH AVE S CITY;AUBURN ST WA ZIP; 980011558 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCK Yes No vEs NO
8 DCIENSE# STATE WA SEXI M MMDDYY' 12 - 09 - 1992 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 9 EJECT 1 N USEET CLASSY 1 NATURE of INJURIES 2=
LICENSE, CV7307J STATE WA V 1J4FJ78S9PL619477 3
10� PI ATP rt
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM To
TRLR TRLR. 7 1 3 33
12 Q Q UIN#' VIN#
FROM TO
VEH.YEAR 1993 MAKE JEEP MODEL CHERO STYLE 4C VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 3 34
13� DAMAGE YES II_II NO `/ YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
5 LIABILITY INSURANCE INSURANCE CO 4
14 AMERICAN FAMILY 4I085-803I9-97
IN EFFECT &POLICY# 9TOP
V""' CHARGE 5 36
LEDgLLy YES❑NO❑ CITATION# t a 80TTOM
15❑ STMDwc 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:4253069616
16�
LAST NAME MAC FIRST NAME BIEN MIDDLE' N
INITIAL
17 STREET ❑ 254 BLAINE CT SE CITY' RENTON ST, WA ZIP 37
980568863
NEW ADDRESS I I I I I 1
❑
18� IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
CDL INTERLOCKYES NO INTERLOCKYEs No NO
19 DRIVER'S STATE IJ
WA SEX F D.O.e. 03 02 1968 39
LICENSE# MMOCSYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS 1 ❑
21 LICEN� 761YWZ raTE WA vIN# 4T3ZF13CX2U468334 41
PLATE22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2002 MAKE TOYT MODEL SIENNA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO VINCENT TRAN 254 BLAINE CTSE RENTON WA 98056 VEHICLE NO.2
SHADE DAMAGEAREA
3
LIABILITY INSURANCE[Z INSURANCE CO STATE FARM 588-8118-COI.47
IN EFFECT &POLICY# 9TOP
LY—ve ❑ ,J—I CITATION# CHARGE t080TTOM
LEGnL YES N`[_
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. EG66136
COLLISION REPORT III III III III III 111
1591972 CASE# 26-101
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 INJURY NATURE OF INJURIES
POS. ' USE GLASS 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
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 01-11-26 05:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1/6/2026 4:39:54 AM
BADGE OR ID# 12788 ORI# WA0171300 TIME POLICE DISPATCHED; 7:13 AM TIME POLICE ARRIVED i 7:27 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5
REPORT NO. EG66136 CASE# 26-101 O OF COLLI 510N TIME 01/05/26 07:13
COLLISION
NARRATIVE
On 01/05/2026, at approximately 0713 hours, I was dispatched to an accident at NE Sunset BLVD
and Anacortes Ave NE 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 Ne Sunset Blvd, coming to
Anacortes in lane #2 (lane #1 being nearest to the curve), traveling eastbound. The driver stated that
all units were following closely behind each other. He said the driver of Unit#2 had braked, and he
had as well, but was unable to stop entirely due to the wet roads. He advised that he was on top of a
puddle. Unable to stop, Unit 1's vehicle collided with Unit#2's rear bumper. Unit#1 vehicle did have
damage to its front bumper.
I spoke with the driver of Unit#2, and she advised that she was in the same lane and traveling in the
same direction as Unit #1. The driver said she stopped her vehicle because Unit #3 was in front of
her, which was also stopped. Unit#2 was then struck on the rear of the bumper, which caused her to
move forward and hit Unit#3's truck from the rear bumper. Unit#2's vehicle met the threshold of
damage to the front and rear of the car.
spoke with the driver of Unit#3, who advised that he was in the same travel lane as Units #1 and #2.
The driver said he was stopped at the red light before being rear-ended by Unit#2. The driver did
receive minor damage.
All drivers claimed no injuries. Vehicles were still drivable. All damages were documented with a
photo and submitted as evidence. Each driver was given a copy of an exchange information form.
I determined Unit#1 was the proximate fault, as he followed Unit#2 too closely, which did not give
him enough time to stop when Unit#2 stopped. If Unit#1 had not followed closely, this accident
wouldn't have occurred, as he would have had enough time to stop.
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,
1/5/2026, at 1005 hours, Renton, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG661 36
POLICE TRAFFIC
1 1 8 27
COLLISION REPORT CASE# 26-101
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY 3
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY STi ZIP
4 ❑ NAME # PLACARD
GWVR NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
{ MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE CYCLE C) PEDESTRIAN :.. OWNER YES NO
D:4252479437
0 1 29
LAST NAME SHARP FIRST NAME I ELIJAH MIDDLE' M
INITIAL
STREET 30
❑ NFW ADORFs 901 SUNSET BLVD NE APT A104 CITY RENTON ST WA ZIP 980568710
6 PRESENT MEDICALTANSPORTED'. 1 1 2 31
CDL IGNITION REtSUIRED I{iNiTiON :: ..
INTERLOCK YES NO INTERLOCK vEs N YES N
DRIVER'S D.O.B L
LICENSE' STATE WA SEX'M MMDD' 02 25 - 2008
7
ON DUTY STATUS AIRBAG 2 RESTR. 9 EJECT 9 HELMET INJURY 1 NAruRE of INJURIES
USE ;CLASS ;
8 ❑ 1 32
LICENSE D00270J TAT WA VIN 1FTYR14X1YTA42175
PLATE#
9 9] TRAILER TRAILER L
PLATE# STATE PLATE# STATE
0
10 ❑ TRLR TRLR
VIN.# VIN#.
11 O O vEH.vEAR2000 MAKE FORD M°DELRANGER STYLE TR VEHICLE TOWE E T ABLIN TOWED BY GovT vEHICI E FROM To
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFONASIROH ABDOL 901 SUNSET BLVD NE APTA 104 RENTONWA98056 7 3 33
12 � SHADE IN DAMAGED AREA
� FROM TO
INSURANCE CO
LIABILITY INSURANCE PROGRESS/VE 995247043
IN EFFECT &POLICY# I JTt1P--_ m 34
13 ❑ ve A" YES NGEII
CITATION# CHARGE 1080TTOM
ecaLLY
s-rANoiNc 3 7
MOTOR PEDAL_ ' 1:1PROPERTY DAMAGE THRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET �' CITY ST' ZIP
NFW ADDRFSS
CDL IGNITION RE6UIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YES NO INTERLOCK YEs Net YES No
17 37
RIVER'SLLIICENSE# STATE SEX MMOD' -
❑
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#::
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT &POLICY# I.. 1�TOP_.__ E. 44
vewc�e ❑ ❑ CITATION# CHARGE 70 BOTiC?M
24 I T ALL,
YES NO
sF__ 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SULIASI TAMAIVENA 01-11-26 05:46 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OR Ib# 12788 O#RI WA0171300 APSKELTON 11612026
PAGE[4 OF
3000-345-013(R 11t18)
REPORT NO. EG66136 CASE# 26-101 DATE AND TIME 01/05/2607:13
OF COLLISION
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PAGE 5 OF 5