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HomeMy WebLinkAbout2026-00002077 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111111111111 I0011110101110100 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X 1068,3 u, 1 U21 3 4 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 5 11 u, 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑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 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00002077 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n ® ❑ RELATED PRIVATE ❑Y ®N 01 11 2026 la— ❑YES ®NO U1 -< BOWES RD Elgin mo /day/yr 05:55 ®PM FLOW CONDITION M 010(D!MI N E S ® South Randall Rd •COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (/) 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 gi DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NOV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FRO TOWED U1 Q Hoshina. Raiden. K. BMW 320 2013 00-NONE ©1 >2T VI i 0 DUE TO CRASH ElNAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE NI 10 1 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ® 0 U2 2 I'T1 M 2 4 SYTM❑Y ®S NE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value 6 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it a 4 COM VEH ❑ El 1 0 ~ ELGIN I N I L 60124 0 1 0 FIRST CONTACT 12 7 ;1 _5 *II Yes.See Sidebar Ut Z HOSHI32 IL 2026 Ismi TELEPHONE IL D 0 WBA3C3C57DF979626 State Farm ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR --1 Elgin Fire 99 9 Hoshina.Gladys 1960615-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑Nov 0 NOV ❑Dv /1 9 9 2 Kia Motors Cooporte 2016 00-NONE 11 i 12..-_1 DUETO CRASH ❑ 2 o -y Yr 13-UNDER CARRIAGE 10� 2 FIRE ❑ ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 POINT OF s 4 COM VEH ❑ ® Ut CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR g �' FIRST CONTACT 6 Q�:I-0'_O•It Yes.See Sidebar C PINGREE GROVE IL 60140 B 1 0 FY70032 IL 2027 REAR Si)0 NJ D 0 KNAFK4A62G5612015 Safeway Insurance Co ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Gomez.Adalberto 4323384-PP-001 SAC 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 11 / 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 11 i 11 /026 05 55 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ,, 0 2 0 28 18 11 /11 /026 06 07 ®PM ElConstruction F R 1 O 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Hoshina. Raiden. K. 11-601 S1542-000642 11 /11 /026 06 12 ®PM SLMT N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility t 2 El ARREST NAME 1/ /11 /026 06 46 ®PM El Unknown work zone type U1 El AM 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1 542 Chafe. Ethan sot 320 Cox 21 / 71 /026 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••--, , I I i I A CMV is defined as any motor vehicle used to transport passengers or property and: Z ___ ___ I I I I 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ` ` -I-- ' I I I I r INDICATE NORTH combination):or p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 4, 1111S ••. v 1 r - _ (example:shuttle or charter bus):or 0 r I I T, L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees In the course of their employment(example:employee X t transporter-usually a van type vehicle or passenger car):or w L L.___a____.I "_ 4. Is used ordesi natedtotrans transport 15 passengers,including y} } } g po passen rs,includi the driver, 1- for direct compensation(example:large van used for specific purpose):or f O L i_--------- t i _ 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m y placarding(example:placards will be displayed on the vehicle). XI . 1 G�.:nlalei 1 _ CARRIER NAME u t -r1Un2 • % Z ® t t t w r — TOA°—' ADDRESS D ®",` N n CITY/STATE/ZIP g 1 i.- i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;____Y____1 - 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'; 0 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 Silver Black 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE