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HomeMy WebLinkAbout2026-00001448 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011 1111 101111 Dl III 0 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 096617* u111 u21 3 4 2 u, 3 U2 1 u, 9 U2 1 u,99 U2 99 1 10 u1 5 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (8:1B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00001448 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 r1 BOWES RD Elgin 02:13 ® ❑ RELATED ®Y 0 N 01 08 2026 ❑AM ❑YES ®NO U1 —< g PRIVATE mo !day!yr ®PM FLOW CONDITION m FT N E S W LONGCOMMON PKWY COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR El SLOW 3 Cl) ❑ Kane HIT ®Y ❑ N WITH VEHICLES INVLD El STOPPED U2 --I CO AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 0 0 9 / yr Dassi. Kai.J. Mercedes-Beri2 L550 2008 00-NONEEN 13-UNDER CARRIAGE ©, OUE TO CRASH El I O 0 FIRE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 U2 3 <<T1 M 9 4 SYSTEM IN ENGAGED 15-OTHER 9 s6.TOP 3 6 ALGN = ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I, 4 COM VEH 0 E! 1 0 H 1- PLATO CENTER IL 60170 0 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 ZFE15140 IL 2026 REAR 7 TELEPHONE IL D 0 4JGBF86E48A323994 None El ❑N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR Same None 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 X N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 row 0 Ncv 0 DV � !1 9 5 8 Chevrolet Express 2014 00-NONE 11_"1 0i.O DUE TO CRASH ❑ 2 x o 13-UNDER CARRIAGE 16( 1. y FIRE 0 ® U2 C M 9 4 SYSTEM IN ENGAGED 15-OTHER 9,16-TOPO3 * 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN Distracter(Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1!:,_ COM VEH ❑ ® U1 toFIRST CONTACT 2 7 . -�_-5 •(ryes.See Sidebar ELGIN IL 60123 B 1 0 719AC913 IL 2025 I 0 N IL D 0 1GCZGTCGOE1182684 National General ❑y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Pingree Grove Fire Same 2026752685 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPOND 0 N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u N 1 ® 11 1 11 /12 /26 02 13 ®PM AM in a Work Zone? ®N DIRP D co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 0 22 3 07 2 11 /12 /26 02 14 ®PM• ❑Construction >F N 3 0 11 1 ZSI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Dassi. Kai.J. 11-306 747675 11 /12 /26 02 30 ®PM SLMT I$[CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM' ❑Utility p N 50 Ti 2 0 11 1 ARREST NAME Dassi. Kai.J. 3-707 747674 11 /12 /26 03 00 ®PM ElUnknown work zone type U1 2 2 3 ID El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 50 273-Tucker.Craig 801 334-Fries 21 / 91 /026 09 00 ❑PM I 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. A CMV is defined asmotor vehicle used to transportand: r ----,5-••--, ; any passengers or property Z 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< } i.-- -i-- --; } } } r -, , ; ; , ; ( INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } ' 1 , } (example:shuttle or charter bus):or X 3. Is L L.___A_. 1 i. <--_- -___� J transporting employened to es Inhecourse 5 or fewer o their eers mplod yment example:employeener X } } } transporter-usually a van type vehicle or passenger car):or CO I- <.__-a-_-_-I , l• I• I- <--_-a-___� , , , , 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L L___-a____.: L L L ...._-.�____� l. i i ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI --I CARRIER NAME Z i. ADDRESS 0 CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate 0 ❑ Not in Comm./Govt. ❑ Not in Comm./Other O USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gold White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE