HomeMy WebLinkAbout26-3108 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 26-3108 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 3 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 N E IN CITY#
COLLISION 04 - 1-- 2026 0607 17 ❑.❑ S 8 W e IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 7TH ST BLOCK e✓ 700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2065549909 0 3 30
6❑ LAST NAME DALEN FIRSTNAME DOUGLAS MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 721 S 31ST ST TON WA
NEW ADDRESS ST 21P 96055 2 CITY REN
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 05 1- 17 - 1978 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATE BLZ1658 sTATe WA VIN#' ZACCJBBB6JPH10973
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 4 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 4 1 34
13 A 2018 JEEP RENEG UT DAMAGE YES NO YES[:] No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14[Al
LIABILITY INSURANCE INSURANCE CO FARMERS 199730186 4
LI EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLvYes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�IJNITU2 VEHICLE ❑ CYCLE ❑ ❑ PROPOWNER ❑ YES1/ No D:4254574171
16 a
LAST NAME SUI FIRST NAME ROSILY MIDDLE L
INITIAL
17❑ STREET ❑', 22908 101ST PL SE CITY KENT ST WA ZIP 98031 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE I WA ]SEX IF D.C.B. 03 _ 26 _ 1998 39
LICENSE# MMDDYY
WELMET INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CLZ8343 TATe WA VIN# 7SAYGDED8RF086063
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2024 MAKE TESL MODEL MODEL Y STYLE SO VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ROSILYSUI22908101STPLSEKENTWA98031 D:4254574171 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO GEIC04621877134IN 1 9TOP
VE"LE ❑ N`L J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SlTIVEN/TAMAIVENA 12812 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99242
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3108
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.
S/TIVENI TAMAIVENA 04-27-26 09:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.SKELTON 9139 5/2/2026 3:51:22 AM
BADGE OR ID# 12812 OR]# ! WA0171300 TIME POLICE DISPATCHED; 6:09 AM TIME POLICE ARRIVED',6:10 AM
PART I PAGE IT]OF 4�
REPORT NO. EG99242 CASE# 26-3108 OF COLLISION
04/22/26 06:07
OF CbLLI510N
NARRATIVE
During this incident, I was equipped with a body-worn camera. It is important to note that the camera
may have captured things I did not perceive, and I may have perceived things not captured by the
camera. This report is intended as a summary of events to the best of my recollection and perception
of what occurred. I have paraphrased conversation(s) and may not include an exact sequencing of
events. Any inaccuracies, omissions, or mistakes are inadvertent.
26-3108
On 04-22-2026, at 0607 hours, I was dispatched to an unknown injury blocking accident located at S
7th St and Rainier Ave S, within the City of Renton, King County, State of Washington.
Unit 1 is Dalen, Douglas J (DOB 05-17-1978), confirmed by his WA Doi photo. Dalen is the
driver/register owner for the 2018 Jeep Renegade bearing license plate WA/BLZ1658.
Unit 2 is Sui, Rosily Lal Biak HL(DOB 03-26-1998), confirmed by her WA Doi photo. Sui is the
registered owner and driver of the 2024 Tesla Model Y bearing license plate WA/CLZ8343.
Unit 2 was occupied by Cuai, Ruth T (DOB 01-01-1961), confirmed by her WA Doi photo. Cuai was
sitting in the passenger seat of the Tesla.
Unit 1 stated that he was on S 7th St on the right turn lane headed northbound on Rainier Ave S. He
said that he thought Unit 2 was going to make the turn, but didn't realize that she had stopped, which
caused him to strike the rear bumper of Unit 2.
Unit 2 stated that she was on S 7th St, in the right-turn lane, headed northbound on Rainier Ave S,
waiting for vehicles to pass by, when she was struck by unit 1.
No complaint of injury for this incident.
I completed a sector collision report. I gave Unit 1 and Unit 2 their information exchange.
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 Si. Tamaivena #12812,
April 27th, 2026, at 0530 hours, Renton, WA.
PAGE 3 OF 4
REPORT NO. EG99242 CASE# 26-3108 DATE AND TIME 04/22/26 06:07
OF COLLISION
4
Zv
}
0
5
A'� I�1$ .H t•"{ Y Z,C. tam
9
VI? i Y 4
v
�yl� 4
�t
I�
bi
Y
{1
t Y
t
rt
a
ti
ss ,
b �
\1F1
PAGE 4 OF 4