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Home My WebLink About25-5218 j ITFC II IIIII III IIIII II IIII IIIII I . 27I OOLCERAF EG09343 COLLISION REPRT 1591971 CASE# 25-5218 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOt`CO A`CENC'Y 4200 3 COUNTY RD NVOLVED CODING 2 PRIVATE WAY ❑ 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 - 15 - 2025 1437 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ BLOCK NO. BURNETT AVE N 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET e S 8 w e N 4TH ST 0 4 29 MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE' ❑ YES Vl NO D:2063591642 0 1 30 5❑ LAST NAME SHUBINA FIRST NAME ANASTASIYA MIDDLE A 1 2 31 INITIAL STREET ❑ 4223 5TH AVE NE NEW CITY, SEATTLE ST WA ZIP 981056517 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NO✓ INTERLOCKYES NO✓ YES D NO;✓ 8 DRIVER'CENS STATE WA SEX F MMDr YY' 11 - 19 - 1986 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY CLASS 1 NAruRE of INJURIES 2 10 LI ENSE' AJT8064 STATE WA VN# 4S4BRBGC4D3225158 3 11[—j— TRAILER STATE TRAILER ,STATE 11 2 5 PLATE# PLATE# FRON TO TRLR rRLR 5 7 33 12 2 5 VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN GOVT VEHICLE 7 7 34 13 1 2013 SUBA OUTBA P4 DAMAGE YES ONO IMWIZ�RS TOWING YEs❑ No✓ REGISTERED OWNER INFO SVETLANA SHUBINA 3506SE6THST RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 1 LIABILITY INSURANCE INSURANCE CO 4 14 AMICA 95094623HE IN EFFECT &POLICY# 9TOP vEnic�E CHARGE 5 36 Lemur YES❑NO❑ CITATION# 7 0 80TTOM 15❑ STMDNc 7 e III MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT O2 VEHICLE CYCLE nWNFR YES,/ NO D:2067507119 16� LAST NAME GONZALES LOBOS FIRST NAME JUAN MIDDLE I P 17 F1 STREET INITIAL 37 ❑ '❑ 303 PARK AVE N APT 0 CITY I RENTON ST, Wq ZIP 98057 4 NEW AbbRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED 38 INTERLOCKYES No�/ INTERLOCK YEs NOF,-/Jl YEs NC ✓ 19 LICIENSE# STATE SEX M MMDDYv 12 31 1994 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HET 2 CLAYUSE 1 NATURE OF INJURIES 40 21 LICENSLATE E CLZ4555 TATE WA VIN# 1NXBR12E8YZ331616 41 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2000 MAKE TOYT MODEL COROLL STYLE p4 VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO�/ YES NO✓ REGISTERED OWNER INFO JUANOONZALEZLOBOS303PARKAVENAPTORENTONWA98057 U:2067507119 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE❑ INSURANCE CO NO INS NO INS IN EFFECT &POLICY# 9TOP _ VEH1— YEs NC❑ CITATION# 5A0571178 CHARGE NO VALID OPER LICENSE WITH VALID OUR LecnLLr 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 RAYMOND WATSON 13127 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG09343 COLLISION REPORT III III III III III 111 1591972 CASE# 25-5218 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL} RODRIGUEZ VAZQUEZ ANITA E (LAST,FIRST ADDRESS&PHONE# 435 PARK AVE N APT 1 RENTON WA 98057 4259702005 SEX' F MMooYYYv 07 — 02 — 1988 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES �' POS. : USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# S ' D.O EX .B.MMDD -F L----------� YYYY EAT HELMETNJURY URE OF PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B.M -T L----------� MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY rNATURE OF INJURIES ❑ Q' POS USE GLASS — ----� 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. RAYMOND WATSON 06-18-25 02:15 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.TRADER 4553 7/13/2025 6:10:55 PM BADGE OR ID# 13127 ORI# WA0171300 TIME POLICE DISPATCHED'; 2:40 Pry/ TIME POLICE ARRIVED 2:43 PM PART B 3 Do-3mx-,ao(Rtlras) PAGE 27 OF 47 REPORT NO.` EG09343 CASE# 25-5218 O COLLI COLLISION TIME OF 06/15/25 14:37 COLLI NARRATIVE 25-5218 This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. On 06/15/2025 at approximately 1440 hours, myself, Officer R. Watson, was dispatched to collision, at the intersection of N 4th ST and Burnett AVE N, in the City of Renton, King County, Washington. Dispatch notes stated that a two-vehicle collision had occurred, no injuries and it was blocking. I arrived on scene and saw two vehicles that appeared to be involved in a collision blocking the two right lanes on N 4th ST at the intersection of Burnett AVE N. Everyone involved appeared to be standing on the sidewalk. When I approached the scene, I asked if there were any injuries or if they would like the medics to come, they all declined and said no one had any injuries. Unit#1, a Green 2013 Subaru Outback WA plate #AJT8064, was driven by Anastasiya A. Shubina (DOB 11/19/1986), confirmed by WADOL photo. Anastasiya said that she was traveling northbound on Burnett AVE N, when she attempted to make a left turn onto N 4th ST, after stopping at the stop sign before the intersection. There was no air bag deployment and Anastasiya said she did not have any injuries. When I asked for her vehicle documentation she provided all documentation. Her vehicle had significant front-end damage and was unable to be driven away from the scene. It was towed by Bankers Towing. Unit#2, a Red 2000 Toyota Corolla WA plate #CLZ4555, was driven by Juan P. Gonzales Lobos (DOB 12/31/1994), ID from Guatemala Consular ID card. Juan said he was driving westbound on N 4th ST when unit#1 hit his vehicle. There was no air bag deployment, and he did not complain of any injuries. When I asked for his vehicle documents he was only able to show me a title from when he purchased the vehicle. He did not have current registration, insurance or a driver's license. His vehicle had minor front-end damage and was able to be driven away from the scene by a licensed driver. Juan was given a citation, citation #5A0571178, for driving without a valid license but provided ID. A witness was near the scene and provided her name, Anita E. Rodriguez Vazquez (DOB 07/02/1988). 1 declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by R. Watson #13127 on 06/18/2025 at 1411 hours in Renton, Washington. PAGE 3 OF 4 REPORT NO. EG09343 CASE# 25-5218 DATE AND TIME i 06/15/25 14:37 OF COLLISION 4 n. sx. yty y N. Yt a t 1 F � � 4 } k 1 � t PAGE 4 OF 4