HomeMy WebLinkAbout2026-00002054 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 1001111010 1101 1011100
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X107949
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 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 1
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
❑AMENDED YR 202612026-00002054 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
674 N LYLE AVE EIin 03:32
® ❑ RELATED ❑Y ®N 01 11 2026 ❑AM YES ®NO U1 -<
_ g PRIVATE mo r day!yr ®PM FLOW CONDITION m
COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n
❑ FT/MI NESW 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
g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
1 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 I�
Kia Motors Co o 2012 00-NONE Q �I 7T DUE TOCRASH ❑
/ yr DI E
13-UNDER CARRIAGE 10 1 2 FIRE 0 NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ID23 U2 2 m
F 2 4 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 99-UNKNOWN THER9 16•TOP 3 •Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, it S 4 COM VEH 0 Ea 1 0
~ ELGIN I L 60120 B 1 0 FIRST CONTACT 12 7 ;1 _5 *Ir Ves.See Sidebar U1
Z Y979735 IL 2024
TELEPHONE
IL D 0 KNADM5A36C6023373 UNINSURED ❑Y ❑N U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 Same UNINSURED 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y ® N 2 0
g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑N,Iv 0 KV 0 CIRCLE NUMBER(S) U1
DV
1 9 9 4 Cadillac ATS 2015 00-NONE 10 t2 c,�2 DUE O CRASH 0 ® U2 2 C
o mo 13-UNDER CARRIAGE
c
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16•TOP 3 X
❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN POINT OF •0istraetlon Value 9 0
S 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR S
t
ELGIN IL 60123 0 1 0 DG79737 IL 2025 FIRST CONTACT 7 Q COM VEH ❑ El Ut CO-5 •If Yes.See Sidebar
REAR C
IL D 0 1 G6AB5RX7F0101155 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Alfaro.Jesus 2289818-SFP-13 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 4 03 /
U1 1 D
/ / 2 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 /11 r2026 03 32 ®AM in a Work Zone? ®N DIRP D
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 0 28 99 01,11 /2026 04 01 ®pM El Construction
R 1 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
z J ❑AM ❑Maintenance U2
a1 ® 11 1 ARREST NAME Ledford. Lori.J. 11-601 1551000293 01/11 /2026 04 04 Igi pM• • 0Utility SLMT
ISI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM
r 2 El ARREST NAME Ledford. Lori.J. 3-414 1551000292 01/11 /2026 03 32 ®PM El Unknown work zone type U1 35
2 2 3 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35
1551-Dede.Joseph 602 320-Cox 02 , 10/2026 09 00 ❑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 -<
c ` --I -' r INDICATE NORTH combination):or —I
BYARROW 2 Is used ordesi nedtotran transport C g sp passengers including the driver
} b_ r . ,. 0
(example:shuttle or charter bus):or X
7
J I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
- }----------J.
} transporte -usually aevan type vehicle orhpass passenger car):(orxample:} } transportingemploymentemployee
— — — —
L }-----}- --; ' • } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
/ - Not 7c Sat. for direct compensation(example:large van used fors specific purose):or
) I 71
L ____a____� _ l. i. i t 5. Is any vehicle used to transport an hazardous material(HAZMAT)thatrequires
y
. placarding(example:placards will be displayed on the vehicle). m
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u�x: CARRIER NAME Z
-- ADDRESS 'n
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nI CITY/STATE/ZIP
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MOTOR CARR.ID 0 Interstate 0 Intrastate
I r ❑ Not in Comm./Govt. 0 Not in Comm./Other
�I. - ----1 - USDOT NO. ILCC NO. rn
XI
Source of above z
IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Black Gold
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 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