HomeMy WebLinkAbout24-7984 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-7984 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 07 - 1-- 2024 2113 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HARDIE AVE SW
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ W e TAYLOR AVE NW
0 1 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO D:8162991183 1 4 30
6� LAST NAME KAHACHO FIRSTNAME CYNTHIA MIDDLE W 1 1 2 31
INITIAL
STREET ❑✓ 510 STEVENS AVE SW APT#S-204 CITY RENTON ST WA 2jp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
LICENSE CGN4073 STATE WA vN# 1HGCV2F95KA018895
10❑ Pr ATE it
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 5 33
12 0 0 VIN#j VIN#
Rom 34
13� VEH.YEAR2019 MAKE HOND MODEL ACCOR STYLE SD VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYERS vOs❑ENo�
HICLE
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
LIABILITY INSURANCE IN CO
14 ❑ POGRESSIVE 965012812
IN EFFECT &POLICY# �1'OP
VEwcLE
15❑ STA'C CHARGE BOTTOM ❑ 36
YES❑NO CITATION# 4A0600364,4A0600364, OP MOT VEH W/OUT INSURANCE,FL
UNIT MOTOR PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLDMET PHONE
1 VEHICLE CYCLE OWNER YES�/ NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YES I I NOF YES t l NOF%/
19 RIVERS� LLIICENS # STATE SEX U MMDDYY �-❑-[= 39
HELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE CLASS 0 ❑
❑ILICENSE 21❑ PLA E# BBL0659 TATE 41
WA VIN# 1N4AL3AP4FC234941 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR 2015 MAKE NISS MODEL ALTIMA STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CARMENJIMENEZONTON 5I HA YES PLACE SW RENTON WA 98057 D:4255242598 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ I POLICY#E CO NONE NAIN 1U��
VEwGLE ❑ CITATION# CHARGE
LEGALLY YES NC:]
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF02477
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7984
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
POS. 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'
I was dispatched to a collision on 07/29/24 at 2115 hours Hardie Ave SW and Taylor Ave NW , in city
Renton, King County WA.
Unit 1 CGN4073 Driver: Cynthia W. Kahacho (DOB 08/30/1995)
Unit 2 BBL0659 Owner: Carmen Jimenez-onton (01/25/1995)
Unit 1 was traveling West on Renton Ave Extension and turned left to head South on Hardie Ave SW.
Unit 1 told me that she was talking on the phone via blue tooth when she ended up hitting the parked
car. She told me she had made that turn a lot of times and tonight she just had been manifesting the
accident and it happen. Unit 1's vehicle was flipped over on its roof. Unit 2 was a parked vehicle not
occupied.
Cynthia was seen by medics on scene and cleared her to go home.
I gave information exchange to both the driver and owner of the other vehicle.
Upon request Kahacho was unable to provide proof of insurance that was valid and was cited for
driving a motor vehicle without insurance. Kahacho had a driver's license that was suspended or
revoked in the third degree and was cited for driving a vehicle while his license was suspended.
Kahacho was also cited for her license tabs being expired since 01/11/2024.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 07-30-24 01:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 81512024 2:27.14 PM
BADGE OR ID# ! 12808 ORI#' WA0171300 TIME POLICE DISPATCHED; 9:15 PM TIME POLICE ARRIVED 9:16 PM
PART I PAGE IT]OF 3�
REPORT NO. EF02477 CASE# 24-7984 DATE AND TIME 07/29/24 21:13
OF COLLISION
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nit
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