HomeMy WebLinkAbout24-12532 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 24-12532 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' BOULDER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 12 - 1-- 2024 1931 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LAKE YOUNGS DR SE BLOCK NO. e✓ 1200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES EET e S ❑ W e ROYAL HILLS DR SE
0 1 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO D:2064957280 30
6 LAST NAME BARON DIAZ FIRST NAME ROSA MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 2025 SE 8 DR TON WA
NEW ADDRESS ST zlp'I 96055 2 CITY REN
❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
7
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'F MID
.O B 07 - 23 - 2002 32
CENSE 9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 . EJECT 1 HELMETU E 2 CLASS INJURY6 [NATURE OFSCRATCHI CHIN,NJURISORECHEST z❑
3
10❑ P1 ATNES# CGW4431 sTAr WAv N# JTDKN3DU2C1533037
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 4 8 33
12❑ VIN#' VIN#.
FROM
34
13❑ VEH.YEAR 2012 MAKE TOYT MODEL PRIUS STYLE 5D VEHICLE TOWED No pLSSBLIN TQ yEq.BLRs YES[:] No
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO VERN FONK 2025721432 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY ✓ DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2538523000
16❑
LAST NAME FALCON RIDGE HOA FIRST NAME MIDDLE
INITIAL
17❑ STREET ❑ 716 W MEEKER ST CITY KENT ST WA ZIP 98032 37
NEW ADDRESS I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 LLIICENS # STATE SEX U MMODYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE LICENSE vIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. 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
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# T AGENCY
26
C.PAGET 8660 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF44144
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12532
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
PM 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'
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.
C.PAGET 12-05-24 10:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 12/10/2024 12:05:27 AM
BADGE OR ID# 6660 OR]#' WA0171300 TIME POLICE DISPATCHED 7:36 PM TIME POLICE ARRIVED 7:50 PM
PART I PAGE IT]OF 4�
REPORT NO. EF44144 CASE# 24-12532 OF COLLISION
12/05/24 19:31
OF CbLLI510N
NARRATIVE
24-12532 One car collision, minor injury
Axon:
Axon body cam available
Narrative:
On 12.05.2024 at 1936 hours, I was dispatched to a one-car vs rock collision that occurred at 1931
hours. The collision occurred in about the 1200 block of Lake Youngs Dr SE (aka Cedar Ridge Dr
SE). Lake Youngs Dr SE is a two-lane road with no barrier that travels southeast to northwest at this
point in the road. The road is NW of Royal Hills DR SE. I arrived at 1950 hours.
I contacted Rosa L Baron Diaz DOB/07.23.2002 and later advised her that our contact was recorded.
Baron Diaz' Blue 2012 Toyota Prius WA/CGW4431 was resting against a large rock 6' that is
engraved with Falcon Ridge Drive. Baron Diaz told me that she fell asleep at hit the rock. I used
language line for Spanish to verify that I understood Baron Diaz about how the collision occurred.
Baron Diaz was identified by photo WADL and her DOL status is valid. Baron Diaz provided her
registration and proof of insurance. Baron Diaz is the legal and registered owner of the vehicle.
Damage to the vehicle was the front bumper, hood, and front side panels. Airbags at the steering
wheel were deployed.
I asked Renton Fire to respond as a precautionary measure due to the airbag deployment. Baron
Diaz showed me an abrasion on her chin and told me that her chest also hurt (from the airbag).
The Falcon Ridge HOA president Micheal Maresma arrived and provided the management company
information:
Around the Clock/Falcon Ridge HOA
716 W Meeker
Kent, WA 98032
253 852 3000
There is no obvious damage to the large rock owned by Falcon Ridge HOA. Video taken with body
camera of the car and the rock.
Copy of Exchange of information given to Maresma and Baron Diaz.
Banker's Towing arrived to tow the vehicle. Baron Diaz had a friend drive her home.
No citations issued.
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 C. Paget/8660 9:57 PM 12/5/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF44144 CASE# 24-12532 DATE AND TIME 12/05/2419:31
OF COLLISION
a
n
�f sf7 `i4
�EP
d
fi� ti7 h 4fk
tiN �
f(
�a5
{
rwV
f�' Ytn
i
{
f y
PAGE 4 OF 4