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HomeMy WebLinkAbout2026-00005886 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets IUI III II IiHiI DIII U II II II HID allDRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004124811 u, 1 u21 1 1 1 u, 2 U2 1 u, 1 u2 1 u, 1 u2 1 5 12 u1 1 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 1215501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00005886 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ROUTE 20 Elgin ® ❑ RELATED ❑Y ®N 01 30 2026 ❑AM ❑YES ®NO U1 PRIVATE mo /day/yr 06:00 ®PM FLOW CONDITION M 025q0/MI NOS W South Mclean Blvd COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 cn Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑Peon. 0 EouES 0 NOV 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) (Wag TOWED U1 Q Geiger-Powell. Natasha. M. 0 6 / yr 13-UNDER CARRIAGE ©i ! FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN O 2 DISTRACTED 0 ]Si U2 2 171 F 2 SY4 ❑Y ONM❑UNK VEH. 0 AT CRASH IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il;� ,_4 0 F. FIRST CONTACT 10 7_ Z Woodstock IL 60098 0 1 0 EJ93700 IL 2025 REAR COM VEH 0 j$J 1_5 *IIYes.SeeSidebar U1 R TELEPHONE IL D 0 3N1AB8CV1 LY309168 Unique Freedom Insurance ❑Y ®N U2 19 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILP3459450 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0 NOV 0 DV � /1 9 9 3 Kia Motors Cooporte 2013 00-NONE ,�_"j t2..-_, DUETO CRASH ❑ ❑ 2 x o Yr 13-UNDER CARRIAGE 'I FIRE 0 ❑ U2 Ti M 2 4 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istractionValue 0 - POINT OF 8 i1 4 COM VEH 0 0 U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR s �f_ FIRST CONTACT 2 Y _, _5 •If Yes,See Sidebar Z West Chicago IL 60185 0 1 0 EK86261 2026 I:EaR 0 N Z IL D 0 KNAFT4A21 D5666301 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 99875381 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < ElYRESPONDER N ui = Y (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 07 / D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 10 1 11 /0/ /026 06 15 ®AM 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 3 n T 0 1 2 0 2 20 / /• _ 0 PM ❑Construction Z3 ❑ ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME / / ID PM ' oN I ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT t 2 ❑ ARREST NAME AM T / / pM El Unknown work zone type 45 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑N 45 1512-Juarez-Huichapan.Juan 700 / / ❑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 -< } }_-__r____; _ combination):or INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 0 _ (example:shuttle or charter bus):or C I Not To Scale • 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O } } } transporting employees in the course of their employment(example:employee X _�� transporter-usually a van type vehicle or passenger car):or C L L.___a____� m • } } } •4. Is used or designated to transport between9and15passengers,includingthedriver. N 1 I for direct compensation(example:large van used for specific purpose):or L L____a....� r 0 - t i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m RQ-e?zD placarding(example:placards will be displayed on the vehicle). m ;0 ui CARRIER NAME Z ADDRESS D 0 n CITY/STATE/ZIPg - i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = TRAILER VIN 1 m to 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 Silver Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO DISABLING DAMAGE El NOT DISABLING DAMAGE DAMAGE EXTENT: 0 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/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE