HomeMy WebLinkAbout26-3730 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-3730 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cowsloN 05 - 1-- 2026 0733 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
S CARR RD MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e TALBOT RD S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2069450620 0 81
30
6 LAST NAME LONG III FIRST NAME JOHN MIDDLE H 1 2 31
INITIAL
STREET ❑ 23620 108TH PL SE APT 1 M101 CITY KENT ST WA 2jp, 980315706 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEXI M MM DAY' 08 1— O6 — 2007 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CW6600 sTArI WAvIN# 2HGF62F7XFH533886
10❑ PI ATE 14
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 TOWED BY GOVT.VEHICLE 3 9 34
13 2 2015 HOND CIVIC 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO 1.LONG 14900 SE 171ST WAYAPTM11 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PATRIOT GENERAL 11410924771 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv YES No CITATION# 6A0298930 FOLLOW VEHICLE TOO CLOSELY o aorrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:7027882579
LAST NAME SHAMSABADI FIRST NAME FARHAD MIDDLE
INITIAL
17 STREET I❑ S❑' 17600 134TH AVE SE APT D206 CITY RENTON ST WA ZIP 980586888 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CUW5613 TArE 41
WA vIN# 4T1B21F69KU011460 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. 'IN#.
VEH YEAR 2019 MAKE TOYT MODEL AVALON STYLE 4p VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO FARHAD SHAMSABADI 17600134TH AVE SE APT D206 RENTON WA 980586888 D:7027882579 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 868182275IN IGD
VEHICLE ❑ ,.I it CITATION CHARGE
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
RAYMOND WATSON 13127 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EHO5111
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3730
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PEREIRA TANYA S
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
17650 134TH AVE SE APT K202 RENTON WA 980586893 SEXi F MMDOYyry 12 - 21 - 1978
{� SEAT : HELMET INJURY NATURE OF INJURIES
PASSENGER LV WITNESS UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 0 UNKNOWN
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&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.
RAYMOND WATSON 05-19-26 05:36 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
PHILIP DAVIS 12018 1 5/22/2026 10:18:11 AM
BADGE OR ID# 13127 ORI# WA0171300 TIME POLICE DISPATCHED! 7:34 AM TIME POLICE ARRIVED',7:39 AM
PART I PAGE IT]OF 4]
REPORT NO. EH05111 CASE# 26-3730 OF COLLISION
05/14/26 07:33
OF CbLLI510N
NARRATIVE
26-3730
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 05/14/2026 at approximately 0734 hours, myself, Officer R. Watson, was dispatched to a collision
with unknown details, at the intersection of S Carr RD and Talbot RD S, within the City Limits of
Renton, County of King, State of Washington.
Dispatch notes stated that there were 2 vehicles, and it was unknown if there were injuries.
I arrived on scene and observed two vehicles stopped in the number 1 lane with traffic going around
them.
Unit# 1, driven by John H. Long (DOB 08/06/2007) verified by WA DOL photo, stated he was driving
a Gray 2015 Honda Civic, WA plate CVV6600. There were no passengers in the vehicle. John stated
that he was traveling westbound on S Carr RD when unit#2 came to stop for the stop light at the
intersection of S Carr RD and Talbot RD S abruptly and he was unable to stop in time to prevent a
collision. John stated he had no injuries and declined aid. When I asked for John `s license,
registration and insurance, he was able to provide me with all documents. Unit#1 had minor front-end
damage, no airbag deployment, and was able to be driven from the scene.
Unit# 2, driven by Farhad Shamsabadi (DOB 08/01/1965) verified by WA DOL photo, stated he was
driving a Gray 2019 Toyota Avalon, WA plate CUW5613. He was driving for a car service and had a
passenger, Tanya S. Pereira (DOB 08/01/1965). Tanya was assessed by Renton Fire Department
Medics on scene and transported to Valley Medical Center for further treatment. Farhad and Tanya
both stated that Farhad was traveling westbound on S Carr RD when he stopped for the stoplight at
the intersection of S Carr RD and Talbot RD S when unit#1 collided with the rear of their vehicle.
Farhad was assessed by Renton Fire Department medics on scene but declined further treatment.
When I asked for Farhad `s license, registration and insurance, he was able to provide me with all
documents. Unit#2 had minor rear end damage, no airbag deployment, and was able to be driven
from the scene.
An exchange of information was given to both parties involved. Unit#1 driver was cited for, following
too closely, due to the driver following too closely to be able to stop in time to avoid a collision
(citation # 6A0298930).
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer R. Watson #1 31 27 05/1 9/2026 0535 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EH05111 CASE# 26-3730 DATE AND TIME 05/14/26 07:33
OF COLLISION
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