HomeMy WebLinkAbout26-2962 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 26-2962 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
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#
cawsloN 04 - 1-- 2026 0821 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LAKE YOUNGS WAY BLOCK NO. e✓ 1600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SE 16TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066696410 0 11
30
6� LAST NAME CAPRON FIRSTNAME HELEN MIDDLE Y 1 1 2 31
INITIAL
STREET ❑ 12957 SE 157TH PL CITY RENTON ST WA 21p 980584705 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� AWX1655 sTATe WAvIN# 1FMCU9J9XGUA30270
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 5 34
13 4 2016 FORD ESCAPE SD YES NO � �MEYERS TOWING YES[:] No✓
DAMAGE
REGISTERED OWNER INFO HELEN CAPRON 12957 SE 157TH PL RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 929510160 <1�3 4
IN EFFECT &POLICY# TOPvEHICLE CHARGE 36
EGALLY YEs NO CITATION# 6A0092336 FAIL TO YIELD MOTOR VEHICLE orrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:8165165431
16 a
LAST NAME SHAHI FIRST NAME SHAKELA MIDDLE N
INITIAL
17❑ STREET ❑', 3000 SE ROYAL HILLS DR APT 34 CITY' RENTON ST WA ZIP 980583865 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19 LDI IVER # STATE WA ]SEX IF M D.C.B. 10 _ 04 1987 39
H USE ET LAU SY COMPLAINT OF PAIN RIGHT HAND ❑F—NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7
21❑ LICENSE BWX2292 TATe I WA VIN# 5TDYK3DC6FS589063
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
24❑ VEH YEAR 2015 MAKE TOYT MODEL SIENNA STYLE VN VEHICLETOWED TO BLIN TOWEDBv GOV HI 44
DAMAGE ves�/ No GENE MEYERS TOWING YES No
REGISTERED OWNER INFO NAQIBULLAH SHAHI 3000 SE ROYAL HILLS DR APT 34 RENTON WA 98058 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU POLICY#E CO pEMCO CA 1919048IN 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
7NELSON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99595
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2962
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SHAH/ MOHAMED S
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
3000 SE ROYAL HILLS DR APT 34A RENTON WA 98058 SEX M MMDDYyry 09 - 16 - 2016
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE of INJURIES
❑✓ � 2 POS. 10 2 4 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) GULBAHRI ABDUL
ADDRESS&PHONE# D O B
3000 SE ROYAL HILLS DR APT 30C RENTON SEX M MMDDY,, 02 _ 04 _ 2016
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 10 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) GULBAHRI TIBIB
ADDRESS&PHONE# 3000 SE ROYAL HILLS DR APT APT 30C RENTON SEX M I. _ 10 _ 2017
MDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT I 10 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 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 04-17-26 02:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 4/23/2026 1:56:26 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED; 8:22 AM TIME POLICE ARRIVED',8:Y9 AM
PART I PAGE IT]OF 5�
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG99595
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2962
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GULBAHRI SAMAYA
(LAST FIRST,
ADDRESS&PHONE#
3000 SE ROYAL HILLS DR APT 30C RENTON WA 98058 SEXi F MMDovyvv 03 - 25 - 2019
SEAT ' HELMET INJURY NATURE OF INJURIES
PASSENGER�WITNESS� UNIT# 2 POS. 10 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS '7 COMPLAINT OF HEAD PAIN
NAME
(LAST,FIRST,MIDDLE INITIAL) SHARIFI ASRA
ADDRESS&PHONE# D O B
3000 SE ROYAL HILLS DR APT 30C RENTON WA 98058 SEX F MMDD -
vvvv
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 10 AIRBAG 2 RESTR. 13 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) SHARIFI SABAHAT
AooREss&PHONE# 3000 SE ROYAL HILLS DR APT 34 30C RENTON SEX MMDDYYYY
_
. F D.O.B. -
PASSENGER WITNESS UNIT# ! 2 SEAT 10 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES
�. POS. USE :CLASS COMPLAINT OF HEAD PAIN
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 04-17-26 02:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 4/23/2026 1:56:26 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED; 8:22 AM TIME POLICE ARRIVED',8:Y9 AM
PART I PAGE 3T]OF 5�
REPORT NO. EG99595 CASE# 26-2962 OF COLLISION
04/16/26 08:21
OF CbLLI510N
NARRATIVE
26-2962 ACCINJ
On 4/16/2026 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 blocking accident in the intersection of SE 16th St
and Lake Youngs Way SE Renton/King/WA. The caller was reporting no injury, but the vehicles were
blocking the intersection.
I arrived on scene and located both drivers, the driver of Unit 1 advised she was not injured and did
not require aid. The driver of Unit 2 advised he had pain in her right hand. I started RRFA as a
precaution.
The driver of the 2016 Ford Escape WA/AWX1655 (Unit 1) was identified by her WADL as Helen Y
Capron DOB: 8/2/1993. She advised she was driving east on SE 16th St and had stopped at the stop
sign to enter the intersection. She said that she began to creep forward and did not see Unit 2, so she
proceeded through and was struck by Unit 2. There was heavy damage to the front bumper and
driver side quarter panel of the Ford and no airbag deployment. Gene Meyers Towing removed the
vehicle from the scene.
The driver of the 2015 Toyota Sienna WA/BWX2292 (Unit 2) was identified by her WADL as Shakela
N Shahi DOB: 10/4/1987. Shakela said that she was driving south on Lake Youngs Way when Unit 1
pulled out in front of her in the intersection. North to south traffic on Lake Youngs Way does not have
a stop sign and has the right of way in the intersection. The Sienna hit a small rock on the southwest
corner of the intersection before coming to a stop in the yard of 1603 Lake Youngs Way SE, other
than the rock being moved there was no damage to the structure or vehicles of the residence.
Shakela was evaluated and cleared by RRFA on scene. There was heavy damage to the front
bumper of the Sienna and no airbag deployment. It was removed from the scene by Gene Meyers
Towing.
Shakela advised she had six children in the vehicle at the time of the collision but had sent them to
school prior to PD arrival. I asked if the children had complained of any pain and Shakela said no. A
mother of two of the children, identified as Samaya Gulbahri 3/25/2019 and Sabahat Sharifi UNK
DOB had complaint of pain to their heads. I advised them to take them to VMC as a precaution if they
wished.
Since Helen had a stop sign and Shakela had the right of way through the intersection, I cited Helen
for RCW 46.61.180.1 Failure to Yield Motor Vehicle under Sector citation #6A0092336. This citation
should be mailed to her DOL address.
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 4/16/2026 Renton WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 2
Seat Position (Passenger MOHAMED SHAHI): 3RD ROW RIGHT SIDE
Seat Position (Passenger ABDUL GULBAHRI): 3RD ROW MIDDLE
Seat Position (Passenger TIBIB GULBAHRI): 3RD ROW LEFT SIDE
Seat Position (Passenger SAMAYA GULBAHRI): 2ND ROW RIGHT SIDE
Seat Position (Passenger ASRA SHARIFI): 2ND ROW MIDDLE
Seat Position (Passenger SABAHAT SHARIFI): 2ND ROW LEFT SIDE
**** END OF AUTO-POPULATED SECTION ****
PAGE 4 OF 5
REPORT NO. EG99595 CASE# 26-2962 DATE AND TIME 04/16/26 08:21
OF COLLISION
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PAGE 5 OF 5