HomeMy WebLinkAbout25-80042 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-80042 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 11 - 1-- 2025 1230 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N LANDING WAY BLOCK NO. e✓ 909
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 500 00 FEET MILES e S B W e PARKAVEN
0 4 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 1 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
DRIVERS
STATE SEX D - 328 LICENSE MDYY❑ M
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 Pi ATNES# CPR3686 sTAT WAV N# JNI6FOBA9RM434777.
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 3 33
12 0 0 VIN#' DIN#
2024 NISS ARIYA nIG ❑ FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO❑BLIN TOWED BY GOVT.VEHICLE111
13 A DAMAGE YES NO �I yES NO
REGISTERED.WNERINFO DAMES HELTON 11406SE 171STST#14 RENTON WA 98055 VEHICLE❑ NO. 1 ❑SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE❑ INSURANCE CO UNK UNK 3 4
IN EFFECT &POLICY#
VEwcLE CHARGE 5 36
LECALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES No 1/ D:2067956330
16❑
LAST NAME GANNON Ill FIRST NAME EDWARD MIDDLE R
INITIAL
17 STREET NEW ADOREs7 1110 N 33RD ST CITY RENTON ST WA ZIP 980561944 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK yEs It I NOF YES t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 07 09 _ 1978 El 39
LICENSE# MMDDYY
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''9 USE 9 0
CLASS ❑
LICENSE I ❑21❑ PLA E# CSF2557 TATe WA VIN# 41
7SAYGDEEOSF285591 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
H ov GI
VEH YEAR 2025 MAKE TESL MODEL MODE!Y STYLE DAMAGE TOWED NOO✓ BLIN TOWEDBY yES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO USAA 01654931OU71037IN 1 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
=ON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12421 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG59042
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80042
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.
D.NELSON 11-21-25 04:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 12/15/2025 2:09:51 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 12:45 PM TIME POLICE ARRIVED',4:00 PM
PART I PAGE IT]OF 4�
REPORT NO. EG59042 CASE# 25-80042 OF COLLISION
11121/25 12:30
OF CbLLI510N
NARRATIVE
25-80042 ACC
On 11/21/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a hit and run collision in the parking lot of 909 N
Landing Way Renton/King/WA. Edward R Gannon DOB: 7/9/1978 was calling to report that someone
had hit his 2025 Tesla Model Y WA/CSF2557 while parking and then moved several rows over and
parked. He advised the suspect vehicle was still on scene and unoccupied.
I met Edward at the scene, and he advised that his Tesla was parked, and he and his wife were in a
nearby restaurant. When they came out, they noticed the damage to the Tesla.
He showed me minor damage to the driver side rear quarter panel. He said that he watched his
surveillance cameras on the Tesla and saw that the suspect vehicle was a blue Nissan Ariya with a
"Nissan" dealer decal where the front plate should be. He said that he was able to locate the suspect
vehicle, a 2024 Nissan Ariya WA/CPR3686 parked several rows over.
I watched the video from the Tesla, and it shows the Tesla parked in the spot with an empty spot to
the driver's side. The Nissan pulls into park and its passenger side front quarter panel collides with
the Tesla. I was not able to identify the driver.
I saw damage to the passenger side front quarter panel of the Nissan.
Edward advised that he did not wish to pursue charges for hit and run and only wanted the incident
documented for insurance purposes.
I took photographs of both vehicles and sent Edward an Axon Link to upload the video.
This report is for documentation purposes only.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 11/21/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG59042 CASE# ' 25-80042 DATE AND TIME 11/21/25 12:30
OF COLLISION
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PAGE 4 OF 4