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HomeMy WebLinkAbout2026-00002267 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0011110111 OIl 0 lI 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X( 147974 u, 1 U21 3 4 1 U1 5 U2 1 U1 1 U2 99 U, 1 U2 1 1 2 U, 5 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 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00002267 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ❑ ® RELATED ®Y 0 N 01 12 2026 ❑AM ❑YES ®NO U1 DUNDEE AVE Elgin04:09 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION IT1 FT!MI N E S W 190 RAMP COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 17 (n ❑ Cook HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I lgI AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 QT3 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 1 0 / yr © 13-UNDER CARRIAGE 10 I 2 FIRE 0 ® C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 Ea U2 rn M 2 SY is-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D O 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, i�a 4 COM VEH 0 Ea 1 0 ~ East Dundee I L 60118 0 1 0 FIRST CONTACT 12 7 ; _5 *IIYes.See Sidebar U1 ZEX12624 IL 2019 REAR TELEPHONE IL D WDDSJ4GB2KN765498 State Farm ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 0314504-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El El 2 0 rg- ❑ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED N PEDAL 0 EWES 0 NMV 0 KCv 0 DV � /1 9 yf 2 Haro 00-NONE 11_' 12' _1 DUE TO CRASH ❑ 0 2 .. 13-UNDER CARRIAGE ,0 i r. 2 FIRE 0 ❑ U2 C c il M 5 3 ❑Y ❑N ElUNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 0 - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iI S i,.�_ COM VEH ❑ ❑ U1 W FIRST CONTACT 7 0,j — _s •If Yes.See Sidebar C ELGINREAR D IL 60120 B 2 8 IL D ❑V ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I X Elgin Fire 1 51 2 SAC E HOSPITAL(TAKEN TO) INCIDENT RESPONDER IF'Y' OWNER STREET,CITY,STATE,ZIP 996 ARefused ❑Y ®N U1 = (UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJ) (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 N 1 ® 13 1 01 /12 r2026 04 09 ®PM in a Work Zone? ®N DIRP co 1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 C) T cii 2 ❑ 28 07 1 / ❑PM ❑Construction G R 1 3 ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 a ® 13 1 ARREST NAME Stephens. Eric.J. 11-601 SO475000699 01/12/2026 04 15 ®pM 0 Utility SLMT uI$[CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 8 N ❑AM 40 t 2 ❑ ARREST NAME Stephens. Eric.J. 11-402-A SO475000698 ! r ❑PM El Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 475-Williarhs. Brianna 201 320-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 truckrtrailer -< i- }____r____; I I } combination):or INDICATE NORTH P1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I I - } (example:shuttle or charter bus):or X ' 1 I I Z 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- I- -A- -•i ` - } } } transporting employees In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C— — — — - } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or o L L--_-a-.... , - l. i i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m rn u�an�. placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z (MR - __ ADDRESS 0D w rn Not To Scale j I �'' ... . " " CITY/STATE/ZIP - i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --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'; ❑Yes 0 No 2 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 Black Blue 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