HomeMy WebLinkAbout2026-00005234 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III H
IM UH UU I IlU
IU
�I111 fl11DD000U
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004119926
u, 1 U21 1 1 1 U110 U2 1 U, 1 1_12 1 u, 1 U2 1 4 12 u1 2 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 1215501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00005234 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 "n
BOWES RD Elgin
® ❑ RELATED ❑Y ®N 01 27 2026 ❑AM ❑YES ®
PRIVATENO U1
mo /day/yr 07:36 ®PM FLOW CONDITION m
010((Ity1 MI N E S ® South Mclean Blvd COUNTY PROPERTY ❑Y 21 N DOORING ❑y #OF MOTOR ®SLOW 15 Cn
Kane HIT&RUN ❑Y ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0
FOR DAMAGEDAREA(S) FROM TOWED U1
rg
Lullie. Michelle.A. 1 2 / yr 13-UNDER CARRIAGE I ! FIRE El
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 2 m
F 2 SYTHER
4 ❑Y ON LINK VEH. 0 AT CRASH IN ENGAGED0 99-UNKNOWN 9 76-TOP 3 `Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 i 4 COM VEH 0 Ea 1 0
~ ELGIN IL 60123 0 1 0 FIRST CONTACT 1 7_; __5 *IIYes.SeeSidebar U1
Z 646AC338 IL 2026 REAR
TELEPHONE
IL D 0 JTEBT17R530009691 nla ❑Y 0 N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same nla 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER >
Refused ❑Y ® N 2 c
N DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 KDV 0 DV CIRCLE NUMBER(S) U1
9 8 0 Toyota Corolla 2003 00-NONE 11 mow DUE TO CRASH ❑ El 2 x
Ti; _ 13-UNDER CARRIAGE FIRE ID ® U2
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOP 3 X
❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracllon Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I 6 i',.4 COM VEH ❑ ® Ut CO
FIRST CONTACT 7 an___,: 6 •• C
ELGIN IL 60123 0 1 0 BV41848 IL 2026 REAR 0 fIf Yes.See SidebaSi)D
IL D 0 2T1 KR32E93C032383 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
99 9 Same 2262168SFP13 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
EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
u 1 ® 11 1 11 ,71 )026 07 36 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
0 2 04 99 / / ❑PM ❑Construction *
R 3 ❑ El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
a D ® 11 1 ARREST NAME Lullie. Michelle.A. 3-707 1528000335 / ! El PM SLMT
ISI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility
t 2 ❑ ARREST NAME Lullie. Michelle.A. 11-905 1528000334 11 (71 (026 07 50 0 PM ❑Unknown work zone type U1 45
2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45
1528-Rivera. Kevin 701 320-Cox 31 , 12 (26 01 30 ®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
A ADDITIONAL UNITS FORMS.
r ----r••--, , tV ; 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 -<
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 n
s7Mole9n?Brvd r r r X
L A p 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
i I ; } } } transporting employees In the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
L I 4. Is used or designated to transport between 9 and 15 passengers,includingC}-----}----; } } g po the driver,
for direct compensation(example:large van used for specific purpose):or O
L i ` l. i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
UnIt7M1 placarding(example:placards will be displayed on the vehicle). XI
—1
CARRIER NAME Z
UnkT#2 O
ADDRESS
D
1 I r i. i. i. i. 4.
CITY/STATE/ZIP g
t c
MOTOR CARR.ID 0 Interstate El Intrastate
r : ❑ Not in Comm./Govt. 0 Not in Comm./Other
Not To Scale USDOT NO. ILCC NO. m
XI
Source of above z
MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Gray Gray
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE