HomeMy WebLinkAbout25-5582 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG08063oc� RA
COLLISION REPORT 1591971
CASE# 25-5582 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 06 - 27 - 2025 1554 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
S 2ND ST BLOCK NO. e 200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 300 00 FEET e✓ S 8 NI a RAINIER AVE S
OF 4 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs V No D:6505207630 0 1 30
6 LAST NAME EVERETT FIRST NAME ELIZABETH MIDDLE B 1 1 2 31
INITIAL
STREET ❑ 39 W NAPA DR CITY I PETALUMA ST CA ZIP 949540000 2
NEW ADDRESS
7 CDL : IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKYE! Nd YES F NOFJ
8 DRIVER # STATE CA SEX F MMor YY 04 — 03 — 1955 t 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET CLASS 1 NAruRE of INJURIES 2
LICENSE, 96012P3 STATE CA yIN 3FTTW8E36NRA66783 3
10[9� PI ATP rt
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR TRLR 3 5 33
12 2 5 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE
13 1 2022 FORD MAVERI DAMAGE vesNo ✓ ves� No 3 7 34
REGISTERED OWNER INFO ELIZABETH EVERETT 39 W NAPA DR PETALUMA CA 949540000 D:6505207630 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 ST FARM 068 7139 E04 OSF
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE t 5 36
Lemur yes❑NO❑ CITATION# 7 o BOTTOM
15❑ sTnNowcQ 7 e
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 Q ❑ PEDESTRIAN ❑ D:2064682627
VEHICLE CYCLE (7WNFR YES NO
16�
LAST NAME TAALLOHI FIRST NAME MELINA MIDDLE I N
INITIAL
STREET ❑ 37
17 ❑ 628 SHATTUCK AVE S APT B CITY RENTON ST, WA ZIP 980572421
NEW ADDRESS
1g❑ CDL IGNITION REQUIRED3 (GNTION PRESENT MEDICALTRANSPORTED: 38
INTERLOCKYES NO INTERLOCK YES N.Fj YEs NOI
19 DRIVER'S STATE WA SEXIF D.02. 08 17 1997 39
LICENSE# MMDDYY
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21 LICENSE CMT7131 TATE WA VIN# 7SAYGDEEXRF150600 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q24 MAKE TESL MODEL MODEL Y STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO MELINA TAALLOH1628SHATTUCKAVESAPTB RENTON WA 980572421 D:2064682627 VEHICLE NO.2
SHADE IN DAGAREA
2
LIABILITY INSURANCE INSURANCE CO SAFECO H2578382
IN EFFECT &POLICY# tGQ
vemae ❑ CL J CITATION# CHARGE
VEAILYHICLE YES N
25 --J
a ' 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG08063
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5582
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
ble/1 If lane 3 into 2/gry lane 4
Within the city limits of Renton/King/WA I responded to a 2 vehicle crash near the 200 block of S 2nd
St.
When I arrived another Renton Officer was on scene and had interviewed both drivers.
Unit 2 was westbound lane 4 on S 2nd St which is a 4 lane one way. She said unit 1 made a left turn
from lane 3 across lane 4 and into her car. She did not complain of injury and damages did not
require a tow truck.
Unit 1 was westbound lane 3 on S 2nd St. She is front out of town and noticed the Safeway shopping
complex and made a quick left turn towards the store but struck unit 2 instead. She did not complain
of injury and damages did not require a tow truck.
Information/insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 7/3/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 07-03-25 01:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 71912025 7:59:12 AM
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:54 PM TIME POLICE ARRIVED 3:54 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG08063 CASE# 25-5582 DATE AND TIME 06/27/25 15:54
OF COLLISION
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