HomeMy WebLinkAbout25-9859 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG54756OLCERA
COLLISION REPORT 1591971
CASE# 25-9859 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`GENC'Y 4200 3
COUNTY RD ❑ INVOLVED CEDING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 11 - 13 - 2025 1029 17 =.= S 8 W E IN OF M 107E a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
108TH AVE SE BLOCK NO. e 18637 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2534099830 0 6 30
5 LAST NAME MYRONETS FIRST NAME ANASTASIYA MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 32235 194TH AVE SE CITY KENT ST WA ZIP 98042973E 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES No INTERLOCIKYES NO YES NO
8❑ LICIENS# STATE WA SEX F MMor YY' 07 — O6 — 2006 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CTV6292 STATE WA VN# WDDGJ4HB4CF921797 3
10[9� PI ATP tt
11[-j- TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
rRLR TRLR 1 5 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2012 MERZ C DAMAGE Yes�No ✓� Yes 1 5 34
REGISTERED OWNER INFO HERMAN DANILEVSKY 34281 SINE APT S201 AUBURN WA98002 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
14❑ ❑ NSURANCE CO 3 4
LIABILITY INSURANCE ❑
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE 70 BOTTOM 5 36
15
srnc NoiN yes❑NO❑ CITATION# SA0909603,5A0909603 FOLLOW VEHICLE TOO CLOSELY,OP B 7 e ..
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE' ❑ ❑ nWNFR YEs No �/ D:4256335380
16�
LAST NAME NGUYEN FIRST NAME DEREK MIDDLE' H
INITIAL
STREET ❑ 37
17� NEW ADDRE SS'❑ 1304 MONTEREY AVE NE CITY I RENTON ST, yyq ZIP 980562898
1g❑ CDL IGNITION REQUIRED (GNTION PRESENT MEDIGALTRANSPORTED 38
INTERLOCKYES No INTERLOCK YES NO Yes NO
19 DRIVER'S STATE WA SEXI M D•0•B. 04 27 1995 39
LICENSE# MMDDYY —
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CSC9892 TATE WA vIN# 2HKYF18796H515566 41
22❑ STATE TILER PATE# STATE ❑ 42
PLATE#
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2QQ6 MAKE HOND MODEL PILOT STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO PEMCO CA 0831422
IN EFFECT &POLICY# t 9TOP
veeiae ❑ ,J—I CITATION# CHARGE tO BOTTOM
LecnLLy YES N`[_
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG54756
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9859
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME CHEN YIAO Z
(LAST,FIRST,MIDDLE INITIAL}
ADDRESS&PHONE#
1304 MONTEREYAVE NE RENTON WA 980562898 SEX' F MMooYYYv 11 - 24 - 1995
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Q' 2 PUS. 9 2 4 1 USE CLASS ;1 ---�
'NAME
LAsr F RST,MIDDLE INITIAL) NGUYEN DIANA H
ADDRESS&PHONE# D C,B
1304 MONTEREY AVE NE RENTON WA 980562898 SEX' F MMDDVVYv 07 _ 22 _ 1993
SEAT HELMET INJURY
NATURE OF INJURIES
PASSENGER �WITNESS UNIT# i 2 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME MIDDLE INITIAL) NGUYEN MEYRIN A
',(LAST,FIRST,
AODREss a PHONE# 1304 MONTEREY AVE NE RENTON WA 98056 SEX F D•U•� 03 _ 02 _ 2023
MMDDYYYY
PASSENGER WITNESS[:] UNIT# 2 SEAT 7 AIRBAG 2 RESTR. 11 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
PUS. USE GLASS �-�---�
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.ARNOLD 11-13-25 11:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/3/2025 8:03:20 AM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 10:31 AM TIME POLICE ARRIVED 10:39 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG54756 CASE# 25-9859 O COLLI COLLISION TIME
OF 11/13/25 10:29
COLLI
NARRATIVE
CC 25-9859
On 11/13/2025 at 1031 hours I was dispatched to a motor vehicle collision at the 18600 block of
108th Ave SE in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling South on 108th Ave SE in the #1 lane approaching the 18600
block. Driver 2 stated that there was a disabled vehicle ahead and that vehicles in front of him were
braking.
Driver 1 stated that she was traveling South on 108th Ave SE in the #1 lane approaching the 18600
block.
Collision
Driver 2 stated that as he was slowing down for traffic ahead of him, the front bumper of Unti 1
collided with the rear bumper of Unit 2.
Driver 1 stated that she did not have time or space to slow to avoid a collision. Driver 1 stated that the
front bumper of Unit 1 collided with the rear bumper of Unit 2.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a motor
vehicle shall not follow another vehicle more closely than is reasonable and prudent, having due
regard for the speed of such vehicles and the traffic upon and the condition of the highway.
Driver 1 also advised that she did not have insurance for her vehicle.
Driver 1 was cited per RCW 46.61.145 and RCW 46.30.020.
1 certify (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. Arnold #12509 at 11:09 on 11/13/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG54756 CASE# 25-9859 DATE AND TIME i 11/13/25 10:29
OF COLLISION
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