HomeMy WebLinkAbout26-3922 STATE OF II I III 1 IIIllI111IN II II I REPORT NO. EH16619 170
27
COLLISION REP FIT 1591971
CASE 26-3922 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CtLLISION' 05 - 21 - 2026 1702 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259430064 2 01
30
6� LAST NAME KIEFFER FIRSTNAME LAINA MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 11425 60TH AVE S CITY SEATTLE ST WA ZIP 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'F MID
.O B 11 1— 16 — 1973 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10� PI ATFBit CSR1949 sTATI WAurN#' JFIZNAE14K8703241
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2019 TOYT GR86 CP DAMAGE YES NO ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO GEICO 4075352999 3 4
IN EFFECT &POLICY# 9TOP
CHARGE
VE—L'
15❑ 1 5 36
LEGALLY YEs❑NO❑ CITATION# 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:6469199463
LAST NAME TESLENKO FIRST NAME IL YA MIDDLE
INITIAL
17 STREET I❑ 3419 MAIN AVE S CITY' RENTON ST WA ZIP 98055 37
NEW ADDREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YES N0F YESt lNOF,/]
19[—] LDI IVERI # STATE WA SEX M M D.C.B.
05 _ 19 _ 1982 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# BMX5649 TATE WA VIN# 2FMPK4AP2JBC62335 41
1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2018 MAKE FORD MODEL EDGE STYLE SI/ VEHICLE TOWED TO BLIN TOWEDev GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO FAHD GUL 88102ND AVE NE#502 BELLEVUE WA 98004 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 5589814D2847AIN 1 9TOP 5
VEHICLE ❑ N`LJ
,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
MICHAEL THOMPSON 13311 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH16619
COLLISION REPORT III III III III III 111
1591972 CASE# 26-3922
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TESLENKO AMELIA K
(LAST FIRST,
ADDRESS&PHONE# D O.B.
3419 MAIN AVE S RENTON WA 98055 SEXi F MMDOYyry 02 - 27 - 2019
-------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. : 10 2 9 1 USE 1 2 CLASS 11
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O E:4
SEX MMDDYVYV
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.
MICHAEL THOMPSON 05-22-26 12:05 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 1 6/30/2026 7:48:43 AM
BADGE OR ID# 13311 ORI# WA0171300 TIME POLICE DISPATCHED 5:02 PM TIME POLICE ARRIVED 5:02 PM
PART I PAGE IT]OF 4]
TIME
REPORT NO. EH16619 CASE# 26-3922 OF COLLISION05/21/26 17:02
NARRATIVE
26-3922
On 05-21-2026 at 1702 hours I was dispatched to a report of a non-injury, non-blocking collision at S
3RD ST and Main Ave S, in the city of Renton, King county, Washington.
Upon my arrival in the 900 block of S 3rd ST Unit 2 was pulled to the curb of the left lane near the
intersection with S Main Ave. Unit 2 was still operational and I instructed Driver 2 to pull around the
corner onto Main Ave S into a parking space. Unit 1 was in a parking space on the north side of S 3rd
ST.
I contacted the driver of Unit 2, identified as Ilya Teslenko (DOB 05-19-1982, verified by WADL
photo). He stated he was driving eastbound on S 3rdth ST when he changed lanes to his left and
collided with Unit 1. Ilya's daughter Amelia K. Teslenko (DOB 02/27/2019) was in the rear seat of the
vehicle.
I then contacted the driver of Unit 1, identified as Laina L. Kieffer (DOB 11-16-1973, verified by
WADOL photo). She stated that she was changing lanes to her right and collided with Unit 2.
The damage threshold appeared to be met on Unit 1, but not Unit 2.
No injuries were reported by anyone involved.
Based on the statements and circumstances of this collision I was not able to determine the
proximate cause of the accident.
I provided both parties with a business card and case number.
I completed an exchange of information and emailed it to both parties.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer Michael A. Thompson #13311 at 2336 on 5/21/2026 in the City of
Renton, King County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 2
Seat Position (Passenger AMELIA TESLENKO): REAR SEAT
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO.! EH 16619 CASE# 26-3922 DATE AND TIME 05/21/26 17:02
OF COLLISION
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