HomeMy WebLinkAbout23-11765 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 4 27c
COLLISION REP FIT 1591971
CASE 23-11765 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 10 - 1-- 2023 1154 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 44TH ST BLOCK NO. e✓ 1700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2532277926 0 3 30
6� LAST NAME MAYSTER FIRSTNAME MARINA MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 5629 209TH ST E CITY SPANAWAY ST WA 21p 983874748 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CAS9823 sTArI WAurN#' JTDKB20U677632889
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 5 4 34
13 4 2007 TOYT PRIUS DAMAGE YES NO �MEYERS YES❑ NO✓
REGISTERED OWNER INFO MARINA MAYSTER 5629209TH STE SPANAWAY WA 98387 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 LIABILITY INSURANCE PERMANENT GENERAL ASSURANCE CORP 53-WA 5704204
IN EFFECTPOLICY# TOPVEHICL CHARGE 36
LECALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062277811
16 a
LAST NAME DAUENHAUER FIRST NAME DANA MIDDLE E
INITIAL
17 STREET NEW ADDRESS 2236 KENNEWICK PL NE CITY RENTON ST WA ZIP 980562295 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSFORTED 38
INTERLOCK YEs❑No� INTERLOCK ves NO/YES ND�
19 LDI IVE STATE WA SEX IF M D.C.B. 09 _ 29 _ 1978 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AZE6017 TArE WA VIN 41
1GNKVGKD7FJ225190 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR 2015 MAKE CHEV MODEL TRAVERS STYLE SI/ VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JASON STANDLEY 2236 KENNEWICK PL NE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#E CO STATE FARM 139 9597-1307-47DIN 1GD
VEHICLe ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7,L
CER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
LI M RIDGEWAY 12500 WA0171300
A
26
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10995
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11765
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STANDLEY HAYDEN G
(LAST FIRST,
ADDRESS&PHONE#
2236 KENNEW/CK PL NE RENTON WA 98056 SEX i U MMDOYyry 07 - 01 - 2009
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESS�',UNIT# ! 2 POS ' 8 AIRBAG 2 RESTR. 4 EJECT USE 2 CLASS '6 COMPLAINTOFHEAD PAIN
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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.
W/LLIAM RIDGEWAY 10-15-23 02:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 1011912023 4:47:42 PM
BADGE OR ID# 12500 ORI#' WA0171300 TIME POLICE DISPATCHED! 11:55 AM TIME POLICE ARRIVED',12:03 PM
PART Ei PAGE IT]OF 4]
REPORT NO. EE10995 CASE# 23-11765 OF COLLISION
10/15/23 11:54
OF CbLLI510N
NARRATIVE
23-11765
At about 1155 hours on 10/15/2023, 1 was dispatched to an accident with injuries that occurred near
1705 NE 4th St (McDonalds) in the City of Renton, King County, Washington. Fire was enroute.
I arrived at the location with FIRE on scene. Unit 1 was a green 2007 Toyota Prius (CAS9823/WA-
Unit 1). The driver was Marina S. Mayster (DOB:03/27/1997 -verified by WADL photo). Unit 2 was a
silver 2015 Chevrolet Traverse (AZE6017/WA-Unit 2). The driver was Dana E. Dauenhauer
(DOB:09/29/1978-verified by WADL photo). Dana's daughter: Hayden G. Standley
(DOB:07/01/2009) was in the front right passenger's seat.
All parties were told they were being recorded.
All parties stated they were wearing their seatbelts. No air bags were deployed. Marina stated she did
not have any injuries. Dana said her neck was stiff/tightening up. Hayden was seen by FIRE for a
complaint of head pain. Hayden was medically cleared by FIRE and did not require hospital transport.
All parties were advised to seek medical follow up if there are any changes.
I spoke with Dana, who said she was traveling eastbound on NE 44th at about the 1700 block, turning
right into the McDonald's parking lot at a very slow speed. While turning right, Unit 2 was rear ended
by Unit 1. Both units pulled into the McDonald's parking lot.
I spoke with Marina, who said she was traveling about 20 mph eastbound on NE 44th St. She was on
her way to Eden Church, located at 12636 SE May Creek Park Dr in Newcastle, WA. Marina said she
looked at her GPS navigation, when Unit 1 struck Unit 2 on the rear end.
I observed minor damage to the rear passenger's side of the rear bumper/hatch of Unit 2. 1 observed
moderate damage to the front passenger's side of the front end of Unit 1. Unit 1 appeared
undriveable and was leaking fluids. FIRE put down absorbent material. Photos of the damage were
taken and uploaded to the case.
I collected insurance information from both parties. I provided each party with a business card / case
number and an exchange of information sheet. Marina requested a tow. Gene Meyers arrived and
completed an owner requested tow.
Unit 2 left the scene. I provided Marina with a courtesy transport to the church in Newcastle.
This concludes my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by W. Ridgeway#12500 on 10/15/2023 at 1357 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO.! EE10995 CASE# ' 23-11765 DATE AND TIME 10/15/23 11:54
OF COLLISION
N
NE 44TH
EmEmm
UNiT 1
LaNfT 2
MCDONACOS 17d5 NE44TH.
PAGE 4 OF 4