HomeMy WebLinkAbout25-80280 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
SASE 25-80280 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
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#
cawsloN 11 - 1-- 2025 1930 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SE PETROVITSK/RD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2067398589 0 11
30
6❑ LAST NAME NGUYEN FIRSTNAME HELEN MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 11308 SE 193RD PL CITY KENT ST I WA 2jp, 980310203 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 1- 05 - 2008 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10[1PI ATE 14 BMV7876 STATE WA V N#' 3N1AB7AP5KY231524
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 1 5 33
12 3 $ VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 34
13 3 2019 NISS SENTRA SD DAMAGE YES�NO YES❑ NO✓ 1 $
REGISTERED OWNER WFO -,L-671242ND AVES SEATTLE WA 98118 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITYINSURANCE� INSURANCE STATE FARM 4420165-D22.47E 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEcnLLv YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066988853
16 a
LAST NAME LIANG FIRST NAME XUEFENG MIDDLE N
INITIAL
17❑ STREET ❑', 22914 114TH WAY SE CITY KENT ST WA ZIP 980312643 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.Q.B. 09 _ 07 1977 El 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ 1 LICENSE CAY2771 TATe WA VIN# 5FNYF6H2XN6001207
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE HOND MODEL PILOT STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO XUEFENG LIANG 22914114TH WAY SE KENT WA 98031 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO COUNTRY FINANCIAL P46A4118922 1 9TOP
IN EFFECT
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
/SABELLA DAN/LYUK 13001 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG57450
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80280
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'
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.
ISABELLA DANILYUK 12-06-25 02:25 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1211112025 2:31:34 AM
BADGE OR ID# 13001 ORI# WA0171300 TIME POLICE DISPATCHED; 7:30 PM TIME POLICE ARRIVED',7:58 PM
PART I PAGE IT]OF 4�
REPORT NO. EG57450 CASE# 25-80280 OF COLLISION
11/30/25 19:30
OF CbLLI510N
NARRATIVE
25-80280
On 11/30/2025 at approximately 1952 hours, I responded to an injury and blocking accident in the
intersection on 108th AVE SE and SE Petrovitsky RD County of King, and the State of Washington.
Dispatch advised that the vehicles have since moved off the roadway into the Fred Meyer parking lot
located at 17801 108th AVE SE Renton WA 98055.
Upon arriving on scene, I saw the two vehicles involved in the collision.
Unit 1 was 2019 Nissan Sentra (LIC BMV7876). The registered owner of the vehicle is LENH, LAN
MY (DOB 11-11-1979) however the driver and sole occupant was family member NGUYEN, HELEN
DUC (DOB 11-05-2008). Nissan sustained very heavy front-end damage and had airbag deployment
on the driver side of the vehicle.
Unit 2 was 2022 Honda Pilot (LIC CAY2771) and the registered owner and sole occupant was
LIANG, XUEFENG (DOB 09-07-1977).
Renton Fire Department was called on scene to check on all involved occupants as there was airbag
deployment for Unit 1. Unit 2 did not sustain any significant damage nor had any airbag deployment.
I spoke to the driver of Unit 2.
Liang stated he was traveling southbound towards Kent, in lane 2 of 2 on 108th Ave SE.
Crossing the intersection at 108th Ave SE and SE Petrovitsky Rd, the collision occurred just south of
the intersection. Traffic came to a stop and the car behind him failed to yield in time, colliding into the
rearend of his vehicle.
Nguyen, driver of Unit 1, stated the same. Nguyen affirmed the collision occurred south of the
intersection as she did not notice the vehicle stopping, due to her being tired.
Unit 1 was inoperable and therefore towed at the owner's expense by their own privately requested
tow.
Both parties were provided an exchange of information.
My involvement in this case was captured on my department-issued Axon body camera. This report is
a summary of events that occurred and is not an exact sequencing of events. Statements have been
paraphrased and summarized. At the time of this call, I was in a full police uniform equipped with a
Renton Police badge and police patches.
This concludes my involvement with this case.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. I. Danilyuk#13001, 12/06/025 at 0215 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. EG57450 CASE# ' 25-80280 DATE AND TIME 11/30/25 19:30
OF COLLISION
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PAGE 4 OF 4