HomeMy WebLinkAbout26-5149 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-5149 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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' 07 - 01 - 2026 1726 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
116TH AVE SE BLOCK NO. e✓ 17450 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SEPETROVITSKYRD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2067136092 0 9 30
6� LAST NAME TAUALA FIRSTNAME LILIA MIDDLE M 1 1 2 31
INITIAL
STREET ❑1 11811 SE 191 ST ST CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ L IIER # STATE yyq SEXI F I D.MM D Y' 08 — 01 — 1983 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CMS8027 sTArI WAvIN# 5TDZK23C37S010290
10❑ PI ATE 94
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 9 9 34
13 2 2007 TOYT SIENNA VN DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO SULAIMAN MUIED 348 LIND AVE SW31 RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4
14 LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066774616
16 a
LAST NAME ALEXANDER FIRST NAME TAMICA MIDDLE D
INITIAL
17 STREET I❑ s❑' 11099 EASTRIDGE DR NE D304 CITY REDMOND ST WA ZIP 98053 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK ves No� YES
NOF]
19[-] LICENSE# STATE WA SEX F MMDDW 11 10 _ 1988 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE of INJURIES ❑ 40
USE CLASS PAIN IN HEAD AND BACK
❑LICENSE I 21❑ PLA E# CVS2813 TArE 41
WA VIN# 1FMCUOJ99DUB83990 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2013 MAKE FORD MODEL ESCAPE STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO,/ YES NO
REGISTERED OWNER INFO TAMICA ALEXANDER 11099 EASTRIDGE DR NE D304 REDMOND WA 98053 D:2066774616 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 862328816IN 1 9TOP
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES[Z NC[:]
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH2O986
COLLISION REPORT III III III III III 111
1591972 CASE# 26-5149
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TAUALA SA!!R
(LAST FIRST,
ADDRESS&PHONE# D O.B.
11811 SE 191 ST ST RENTON WA 98058 SEX U MMDDYyry - -
PASSENGER WITNESS [UNIT-# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. 9 2 4 1 USE 2 CLASS 1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# Ly O
SEX' MMdDYBYYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
26-5149
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 07-02-2026 1 was working as a police officer in the city of Renton. At approximately 1727 hours I
was dispatched to the report of a blocking collision at 17400 116th Ave SE, City of Renton, County of
King, WA. This incident was captured on my department issued Axon body camera.
According to the notes in the call, two motor vehicle collision, no injuries, and blocking.
I arrived on scene and contacted the drivers of both units. The driver of unit 1 advised she saw unit 2
stopped at the stoplight. She tried to brake and could not stop in time. Unit 1's front bumper collided
with unit 2's rear bumper. 1 photographed both vehicles. Unit 1 was eventually towed by Gene Meyer.
Unit 2 was driven away on its own power.
The driver of Unit 2 complained of back and head pain. She was evaluated by Renton Fire and
cleared medically.
I provided a case number to both parties.
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 S. Fajarillo #12847 on 07/10/2026 @ 1614 hours in Renton WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
STEVEN FAJARlLLO 07-10-26 04:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 7/15/2026 10:44:16 PM
BADGE OR ID# ` 12847 OR]#' WA0171300 TIME POLICE DISPATCHED 5:27 Pry] TIME POLICE ARRIVED',5:36 PM
PART I PAGE IT]OF 3�
REPORT NO. EH2O986 CASE# ' 26-5149 DATE AND TIME 07/01/26 17:26
OF COLLISION
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