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HomeMy WebLinkAbout2026-00001122 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 ll 111110111101111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04O9B640 U111 U21 1 1 4 U199 U299 U1 1 1_12 1 1.11 1 U2 1 5 12 u, 1 U218 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00001122 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 01 07 2026 IMAM ❑YES El NO U1 -< RT20 WB Elgin mo /day/yr 06:07 ❑PM FLOW CONDITION m _ ®.1 FT/® N E s © South McLean Blvd COUNTY PROPERTY 0 Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O 183 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n NT TOWED U1 Q NAME(LAST,FIRST,M) g mo yr Agredano. Norma Ford Fusion 2007 00-NONE ,, • 12 , DUE TO CRASH 0 13-UNDER CARRIAGE FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O DISTRACTED 0 0 U2 4 M F 2 4 ❑Y ® is-OTHER SYSTEM ❑UNK VEH. O AT CRASHD O 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S_iL i 4 COM VEH 0 j$J 2 O F• FIRST CONTACT 1 7_;—_;__5 *Irves.See Sidebar U1 Z Chicago IL 60638 C 1 0 FD94689 IL 2026 REAR TELEPHONE IL D 0 3FAHP07117R131726 United Equitable ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR Elgin Fire 99 Same ILU013550 2 m "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Provena St.Joseph ❑Y ElN 2 0 rg- E{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑row 0 NOV ❑DV /1 9$6 Chevrolet Equinox 2021 00-NONE 1U-I t2 c,�2 FIRE DUE ID CRASH 0 ® U2 2 73 C o _ 13-UNDER CARRIAGE M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraetlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 'i 6 il;, 4 COM VEH ❑ ® u1 CO C FIRST CONTACT 7 Q __,�_5 •(ryes,See Sidebar ELGIN IL 60123 0 1 0 FA25499 IL 2026 I Si)0 Z IL D 0 3GNAXSEV5MS115960 State Farm ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 Same 0365198-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 co U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 11 1 11 ,12 /26 06 20 ❑PM in a Work Zone? ®N DIRP D 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 � o", 2 ❑ 20 99 11 !12 /26 07 10 PM ❑ ❑Construction >F Z3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ®AM El Maintenance U2 -a ARREST NAME 11 /12 /26 07 1 5 ❑PM ' o N ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility SLMT , 55 t 2 ARREST NAME AM 7 / / ❑❑PM 0 Unknown work zone type u1 El n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 — ❑AM Workers present? 0 Y 55 434-McNamara.Shane 702 , / ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` --I -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or ret.nd N 3. Is desgned to carry 15 or fewer passengers and operated a contract career O - }----A----J. ` } } } transporting employees in the course of thir employent(example:employee X transporter-usually a van type vehicle or passenger car):or w ' I. 4. Is used or designated to transport between 9 and 15 passengers,including (I) --- ----+ -_ - } } } g po passen rs,indudi the driver, ■t V for direct compensation(example:large van used for specific purpose):or O < <____a____� r � � o _ l. i. i i. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m h placarding(example:placards will be displayed on the vehicle). ;p I—I - —I CARRIER NAME Z I I i ADDRESS 'n V) ICITY/STATE/ZIP g MOTOR CARR.ID ElInterstate ElIntrastate -_ __ I I ❑ Not in Comm./Govt. Not in Comm./Other ‘I. _Y _ USDOT NO. ILCC NO. 0 XI Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m X) IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE