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HomeMy WebLinkAbout2026-00001879 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mil lli 11 lIII DIII U ll 11111011111111111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004056590* u1 9 U21 1 1 1 u1 2 U2 1 U1 99 U2 1 u,99 U2 1 1 10 u, 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ❑ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 E]NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00001879 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 —n ® ❑ RELATED ❑Y ®N ❑AM PRIVATE 01 1 O 2026 ❑YES ®NO U1 —< KI M BALL ST 1 N GROVE AVE Elgin mo /day/yr 01:50 ®PM FLOW CONDITION m ®23e&MI N E S © Grove Ave COUNTY PROPERTY ❑Y ® N DOORING ICI #OF MOTOR ❑SLOW 15 Cn Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 / / FOR DAMAGEDAREA(S) FROM TOWED U1 Unknown.0. Toyota RAV4 2006 00-NONE ,1,• ,zI-0 OUETOCRASH ❑ VI E NAME(LAST,FIRST.M) mo yr 13-UNDER CARRIAGE IE '10' ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTEDU2 2 < 9 9 SYSTEM IN Y O ENGAGED 0 15-OTHER 9 16.TOP 3 0 _ ❑ ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Vatuc 9 ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T_iL a ii,4 COM VEH 0 j$J 1 0 I— 0 9 0 FIRST CONTACT 1 7_; __5 *uYes.See Sidebar U1 Z K857590 IL 2026 E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 JTMZK32V865002506 Unknown ❑v ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 99 E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 1Av 0 Ncv 0 DV /1 9 y 9 Toyota RAV4 2018 00-NONE O, FRQj.-_, DUETO CRASH ❑ 2 73 ... 13-UNDERCARRIAGE tai lc 2 FIRE ❑ ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ION DUNK VEH. AT CRASH 99-UNKNOWN `Distract on Value 9 0 POINT OF 8 i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1:_ C FIRST CONTACT 11 7 -r_5 C. If Yes.See Sidebar HANOVER PARK IL 60133 0 1 0 ZY97649 IL 2026 Si)0 IL D 2T3ZFREV8JW495737 Founders Insurance Compan ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Velasquez. Uriel QPIL100392 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / U1 1 D / 1 0 EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z u 1 ® 11 1 01 /10 /2026 03 16 ®PM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 C) T v 2 0 2 99 / / 0 PM ❑Construction Z3 0 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 —a, ARREST NAME / / ID PM ' oN ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT T 2 ❑ ARREST NAME AM c- T / / pM El Unknown work zone type 30 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 566-Lopez, Eric tot 337-Thompson r / 0 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 truck trailer -< ` ` -' -' I. INDICATE NORTH combination):or —I r BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ .:.. -:. i : 1. ® - } (example:shuttle or charter bus):or 0 3. Is designed to}- -- i carry15 or fewer passengers and operated I a contract carrier O --- ---- - I' I- I. transporting employee � �In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a__ —— 1 4. Is used ordesi natedtotrans rtbetween9and 15 passengers,including y} } • for direct compensation(example::large van used for speific purpoe):or the driver. L L----a--- ) I ( - t I . I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m placarding(example:placards will be isplayed on the vehicle). ;p CARRIER NAME Z I z I I I I I I ADDRESST. I rn i. i. i. i. 4. n Net 7bSaab Imo) CITY/STATE/ZIP 5 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other I. ------- - USDOT NO. ILCC NO. rn XI Source of above z . 0 Yes II No ❑ Unknown A 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 Xl IDOT PERMIT NO. WIDELOAD' ❑Yes 0 No 2 TRAILER VIN 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. w Red Red u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 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