HomeMy WebLinkAbout24-9196 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 88 27c
COLLISION REP FIT 1591971
SAS 24-9196 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑28
TRIBAL UNITS 01 STRUCK' RETAINING WALL
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. O9 - 01 - 2024 2312 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD N BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BRONSONWAYN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254798338 30
6� LAST NAME CARDONA-ADAMS FIRSTNAME MISHA MIDDLE L 1 2 31
INITIAL
STREET ❑ 313 GLENNWOOD CT SE CITY RENTON ST WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑
USE CLASS j I SWELLING IN THE LEFT ARM FROM AIR BAG
3
10❑ Pl ENSEATE 14 CME5093 STATE WA u N#' 2FMPK4G9XHBB69257
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12❑ VIN#' VIN#
FROM
34
13� VEH.YEAR2017 MAKE FORD MODEL EDGE STYLE UT VEHICLE TOWEDNOOpLSABLIN TSIYYEp9vMEYERTOWING YOs❑ENo /
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO MIS.CARDONA-ADAMS 313 GLENNWOOD CT SE RENTON WA 98056 D:4254798338 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NA <53 4
IN EFFECT &POLICY# TOPVEHICE CHARGE 36
LEGALLY YES❑NO CITATION# OTTOM
15❑ STAIN.D'ING 7 6
UNIT a2 VEHICMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME 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�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIRIVERISTICENS # STATE SEX MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PIR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN It IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VEHICLE ❑ I—I CITATION# CHARGE
LLY i o BOTTOM
LEGA YES N
,.
25 s e
7PETERSON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGEN26 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF12965
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9196
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 09/01/24 at 2314 hours at Sunset Blvd N and Bronson Way N, in
city Renton, King County WA.
Unit 1 CME5093 Driver: Misha L. Cardona-Adams (DOB 03/18/1984)
Unit 1 was traveling South on Sunset Blvd N and when approaching Bronson Way N intersection Unit
1 said they got cut off and then crashed into the 405 overpass wall. Unit 1 could not tell me what lane
they were in or not sure what happen besides being cut off and crashing into the wall.
The driver was seen and treated on scene by fire for minor injurys.
Upon request Cardona-Adams was unable to provide proof of insurance that was valid and was cited
for driving a motor vehicle without insurance. Cardona-Adams 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.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 09-04-24 11:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 9/8/2024 10:23:34 AM
BADGE OR ID# 12808 OR]# WA0171300 TIME POLICE DISPATCHED 11:14 PM TIME POLICE ARRIVED 11:16 PM
PART I PAGE IT]OF
REPORT NO.! EF12965 CASE# 24-9196 DATE AND TIME 09/01/24 23:12
OF COLLISION
v.
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