HomeMy WebLinkAbout25-6403 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG16648oc� RA
COLLISION REPORT 1591971
CASE# 25-6403 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCO A`OENC'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
coulsloN' 07 - 25 - 2025 1656 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
SW 7TH STREET BLOCK NO. e 0 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ C------�. FEET e S 8 W e LIND AVE SW
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:2065180649 0 1 30
6 LAST NAME ALLEN FIRST NAME CLIFFORD MIDDLE 1 1 2 31
INITIAL
STREET ❑ 1821 E MERCER ST APT 2 CITY SEATTLE ST WA ZIP 98112 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYEs NOR] INTERLOCKYEs NO�/ YES F NoF,/
8❑ LICIENS# STATE WA SEX M MMor YY' 07 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 LICENSE
ti� AE98192 STATE AZ VN# 1GDY72CA6E1902695 3
TRAILER STATE TRAILER ,STATE
11 1 5 PLATE# PLATE# FROM TO
rRLR TRLR 5 7 33
1 1 5 VIN# VIN#
( FROM TO
2
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2014 GMC BANANA TR DAMAGE YES No ✓ YEs❑ No 1 5 34
REGISTERED OWNER INFO U-HAUL CO OFARIZONA 2727 N CENTRAL AVE PHOENIXAZ 85004 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE NSURANCE CO 3 4
14 REPWEST 5012
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ sTnNowc 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT vEHICLE CYDLE' ❑ ❑ rwNFR YEs,/ No D:2068417484
16�
LAST NAME SAN JOSE FIRST NAME LISA MIDDLE' D
INITIAL
17 STREET'❑ 120 6TH AVE S 703 CITY SEATTLE ST, WA ZIP 98104 4❑
37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNfT10N PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES X YES No YES ND
19 DRIVER'S STATE WA SEX F MDD 02 04 1972 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG'6 RESTR 4 EJECT 1 HELMET 2 INJURY' 6 NATURE OF INJURIES 40
USE CLASS COMPLAINT OF NECK,SHOULDR,LEFT SIDPAIN W
21 LICENSEPLATE# CMS0391 rare WA vIN# VWPD63B22P357449 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
TOWED BY GOV HI 44
VEH.YEAR 2002 MAKE VOLJ( MODEL,IETTA STYLE $D DAMIAGE TOWED,/ No BLIN BANKERS YES NO
24
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 545.6078-CO5.47
IN EFFECT &POLICY# CDTOP
veeicLe ❑ ,J—I CITATION# CHARGE �gOTTOM
Lecnllr YES N J
25=
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MICAELA CASTAIN 12573 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG16648
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6403
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MATEVOSOVA SED
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# DOB
12091 44TH PL S TUKWILA WA 98178 2067557598 SEX' M MMDDYYYY 10 - 26 - 1949
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS ---�
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
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.
MICAELA CASTAIN 07-25-25 07:20 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.CHRISTIANSEN 10437 81612025 8:17:10 PM
BADGE OR ID# 12573 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 4:57 PM TIME POLICE ARRIVED 5:00 PM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG16648 CASE# 25-6403 O COLLI COLLISION TIME
OF 07/25/25 16:56
COLLI
NARRATIVE
On 07/25/2025 at approximately 1656 hours I was dispatched to an Unknown Injury Accident at SW
7th Street and Lind Ave SW, in the City of Renton, King County, WA.
While in route, dispatch advised there was a 2-motor vehicle accident involving a U-Haul truck.
Upon arrival, I contacted both parties. The driver, Clifford Allen (DOB 07/09/1941), of Unit 1 was
outside the U-Haul and walking. Allen declined medical aid. The driver, Lisa San Jose (DOB
02/04/1972), of Unit 2 was still sitting in her Volkswagen Jetta due to the U-Haul's front bumper
positioned into the driver's side door of the Jetta. San Jose requested Renton Fire to evaluate her,
due to complaints of pain to her neck, shoulder, and left side. San Jose was not transported by EMS,
however informed me that she planned on receiving care from the hospital.
Both parties relayed the following to me. Unit 1 was facing northbound on Lind Ave SW stopped at a
red light. Unit 2 was facing southbound in the parking lot of 550 SW 7th Street stopped at the red
light. Both Unit 1 and Unit 2 received the green light at the same time. Unit 1 had a "left turn yield on
green" sign posted on the signal light pole. Unit 1 did not have a green arrow, however had a solid
green light. Unit 1 attempted to make a left-hand turn onto SW 7th Street to travel westbound. Unit 2
traveled through the intersection to travel southbound onto Lind Ave SW. While in the intersection
both vehicles collided into each other.
Unit 1 didn't realize that he did not have the right of way, and he thought he was able to turn left on
the green light.
There is heavy front-end damage and driver side damage to Unit 2. Unit was towed by Bankers
Towing. There is minor damage to the driver side front bumper of Unit 1. Unit 1 was able to drive
away from the scene under its own power.
A witness, Seda Matevosova (DOB 10/26/1949), informed me that he was behind Unit 1 during the
collision and observed the same that was described above.
Based off the statements from all parties, there is proximate cause for Unit 1 in the collision.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Castain #12573 7/25/2025 Renton, WA
PAGE 3 OF 4
REPORT NO. EG 16648 CASE# 25-6403 DATE AND TIME i 07/25/25 16:56
OF COLLISION
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