HomeMy WebLinkAbout24-9705 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-9705 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' MAILBOX
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 09 - 1-- 2024 2054 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
TAYLOR AVE NW e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e NW 4TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255467876 30
6� LAST NAME TACARDON FIRSTNAME DIA MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 7512 132ND AVE NE CITY KIRKLAND ST WA ZIP 98033 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10❑ P1 ATNES# CML3202 sTAr WAu N# KMHDU46D19U632482
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
TRLR. TRLR. 1 5 33
12❑ VIN#' VIN#
FROM
34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /[g GOVT.VEHICLE
13 4 2009 HYUN ELANTR SD DAMAGE YES NoRS TOW YES❑ No✓
REGISTERED OWNER INFO DIA TACARDON 7512131ND AVENE KIRKLAND WA 98033 D:4255467876 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2024159785 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 U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062489305
16❑
LAST NAME SKY LANAI APTS FIRST NAME MIDDLE
INITIAL
17 STREET NEW ADDREs7 360 TAYLOR AVE NW CITY RENTON ST WA ZIP 98057 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX U MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
1
PLATE#
42
22❑ PIR I I TRAILER LATE# 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
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
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. EF16918
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9705
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 NJURY 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 09/15/24 at 2055 hours at 360 Taylor Ave NW, in city Renton, King
County WA.
Unit 1 CML3202 Driver: Dia M. Tacardon (DOB 03/15/1989)
Unit 1 was traveling South on Taylor Ave NW approaching NW 4th St when she heard her phone
ring, and she went to downshift the vehicle and her foot got stuck under the pedal. She then drove
into the bushes and panicked and ended up hitting all the mailboxes on the Sky Lanai apartment and
ended up crashing into the power pole. Unit 1 stated she was not speeding just panicked and didn't
know what to do.
Property Manager came out and was given a case number as reference.
The driver was seen by fire on scene and had no injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 09-15-24 10:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 9/21/2024 5:44:25 AM
BADGE OR ID# 12808 OR]# WA0171300 TIME POLICE DISPATCHED! 8:55 PM TIME POLICE ARRIVED'8:56 PM
PART Ei PAGE IT]OF
REPORT NO.! EF16918 CASE# 24-9705 DATE AND TIME 09/15/24 20:54
OF COLLISION
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