HomeMy WebLinkAbout24-558 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE42575 170
27
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# z4-sss 2 0 5
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 01 - 1-— 2024 1713 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 180TH ST BLOCK NO. e✓ 8500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET e S ❑ W e LIND AVE SW
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065658888 0 11
30
6� LAST NAME WORKALEMAHU FIRSTNAME AFENIGUS MIDDLE B 1 1 2 31
INITIAL
STREET ❑, 3900 SOUTHCENTER BLVD APT A3 CITY TUKWILA ST WA 7jp, 981882278 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� BKS3675 sTArI WAvIN# JTDKBRFU6J3592733
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO 7 $ 34
13 8 2018 TOYT PRIUS YES❑ NO✓
REGISTERED OWNER INFO AFENIGUS WORKALEMAHU 3900 SOUTHCENTER BLVD APT A3 TUKWILA WA 98188 D:2065658888 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILY CONNECT A104012840 3 4
IN EFFECT &POLICY# 9TOP
ve'CLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064964164
16 a
LAST NAME WOOD FIRST NAME SUSAN MIDDLE R
INITIAL
17 STREET❑ NEW ADORE57 17630 143RD AVE SE APT D103 CITY RENTON ST WA ZIP 980589238 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E�S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs W I NOF YEs t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# A6931167 TArE 41
WA vIN1 1C4RJEBGXLC102291 1
42
22❑ PILER LATE# STATE pLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2020 MAKE JEEP MODEL GRAND STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SUSAN WOOD 17630143RD AVE SE APT D103 RENTON WA 980589238 D:2064964164 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 6148-75-40-62IN 1ULlliKOTlTlfll;0-
"cE-SVEHICLE ❑ ,.I—I CITATION# CHARGELEGALLY YES N`LJ25 7p-,
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE42575
COLLISION REPORT III III III III III 111
1591972 CASE# 24-558
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
PM 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.
P.LANTAGNE 01-16-24 06:44 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1/21/2024 2:21:44 PM
BADGE OR ID# 12575 OR]# WA0171300 TIME POLICE DISPATCHED 5:15 PM TIME POLICE ARRIVED]5:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE42575 CASE# 24-558 OF COLLISION
01/16/24 17:13
OF CbLLI510N
NARRATIVE
24-558
On 01/16/2024 at approximately 1715 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred in approximately the 8500 block of S 180th ST, which is located in the City of
Renton, County of King, and the State of Washington. I responded in my fully marked police vehicle,
wearing my patrol uniform.
I arrived on scene and observed Unit#1, a 2018 Toyota Prius with license plates BKS3675 issued out
of Washington State, and Unit#2, a 2020 Jeep Grand Cherokee with temporary registration
A6931167, blocking the inside westbound lane of S 180th ST and the center two-way turn lane. I was
advised there were no injuries.
I contacted the driver of Unit#1, Afenigus B. Workalemahu (DOB 10/10/1983), who told me the
following: Workalemahu was driving his vehicle eastbound in the inside lane of S 180th ST in
approximately the 8500 block. Workalemahu merged into the center two-way turn lane and the left
front of his vehicle was struck by Unit#2.
1 contacted the driver of Unit#2, Susan R. Wood (DOB 11/01/1978), who told me the following: Wood
was driving her vehicle eastbound in the inside lane of S 180th ST in approximately the 8500 block.
Wood merged into the center two-way turn lane and before she could make the left turn into Ikea, the
vehicle to her right merged into the center two-way turn lane and struck the right front side of her
vehicle.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant crumple damage to the front left fender and
front driver's side door. Unit#2 had significant damage to the right front fender, front bumper, and
crumple damage to the hood.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Wood and Workalemahu.
1, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1835 hours on 01/16/2024 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EE42575 CASE# 24-558 DATE AND TIME 01/16/2417:13
OF COLLISION
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