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HomeMy WebLinkAbout2026-00006001 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets IIIIII 11 IIII MUH U �� IlU II UI H flllIU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X 1236 2 u, 1 U21 3 4 3 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 1 10 u, 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A 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 El NOT ON SCENE(DESK REPORT) (8:1B Injury and for Tow Due To Crash El AMENDED YR 202612026-00006001 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 01 31 2026DAM ®YES 0 NO U1 -< RT20!LAMBERT LN Elgin PRIVATE mo /day/yr 12:20 ®PM FLOW CONDITION m • 020 ®!MI N E s © RT201 LAM BERT LN COUNTY PROPERTY ❑Y ® N DOORING ICI #OF MOTOR ElSLOW 15 u) Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 IR:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EouES 0 Nuv 0!Cu 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 7 yr 13-UNDER CARRIAGE I FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0 U2 4 <<Tl F 2 4 SY❑Y ®SNEM DUNK VEH. 0 AT CRASH IN 0 15-OTHER 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_a 1, 4 COM VEH 0 0 1 O ELGIN IL 60120 0 1 0 FIRST CONTACT 11 7 ; _5 *It Yes.See Sidebar U1 ZEY90363 IL 2026 TELEPHONE IL D 0 WBAXH5C57DD108011 STATE FARM ❑Y ®N U2 1-- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 3775917SFP13 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c m �{ DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL 0 EWES 0 NMV 0 NO/ 0 DV '1 9 6 1 Kia Motors Corielluride 2020' 00-NONE O, Qj-_, DUE TO CRASH ❑ 2 o 13-UNDER CARRIAGE I. FIRE 0 ® U2 C c M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 POINT OF s i 4 C.OM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1:._ C FIRST CONTACT 11 7 —r_5 •If Yes,See Sidebar Z CHESAPEAKE VA 23320 B 1 0 U U F4671 VA 2026 I 0 Si) Z VA D 0 5XYP34HC3LG094384 LIBERTY MUTUAL ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same A0V231 64709375 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 01 ,31 ,2026 12 20 ®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 1 C) T o� 2 ❑ 2 15 , , ❑PM ❑Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ❑ 11 1 ARREST NAME Corona-Garcia.Adriana 11-901-A 456-441 t r ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility t 2 El1 1 2 ARREST NAME 01 r 31 12026 01 00 ®PM ❑Unknown work zone type U1 El AM 55 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 55 456-Roma-o.Carmine 302 02 , 17,2026 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 ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z f ( r JI 1 ' L ® f combination):. Hasorratingmore than pound (example:truck or truck trailer 1. a weight 10 000 5 � -< INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver } } ILI - } r (example:shuttle or charter bus):or C noutEm H� 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O < <----A--_ 1 �„-'„aro y l' } } transportingemployees In the course of their employment i transporter-usuall a van type vehicle or passen car):(orxample:employe e L L.__-a__ — — — — — . HIT2 - I. I I 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. y for direct compensation(example:large van used for specific purpose):or L L-___a----. L i i. L 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires D placarding(example:placards will be displayed on the vehicle). m A L L .r CARRIER NAME Z —I I No..-t To See--� O l. ADDRESS -. - -' _ D rn CITY/STATE/ZIP 0 0 ILemeelt?Ln _ i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5 ' r I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 i "Y""1 USDOT NO. ILCC NO. C m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ 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 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 Black Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE