Loading...
HomeMy WebLinkAbout2026-00002605 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0011110100 fl IOU 110 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X004108021 u, 1 U21 1 1 3 U1 4 U2 1 u, 1 1_12 1 u, 2 u2 1 1 11 u, 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT El 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 31,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00002605 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ❑Y ®N 01 14 2026 ®AM ❑YES ®NO U1 -< ROUTE 20 HWY Elgin07:45 g PRIVATE mo /day/yr ❑PM FLOW CONDITION m 0 !MI N E S Shannon COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 6 Co ® © Pkwy Kane HIT&RUN ❑Y ® N WITH VEHICLESINVLD ® STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n I330P,r TOWED U1 Q NAME(LAST,FIRST,M) Goldentsteln,Caleb,J. mo Subaru Outback 2009 00-NONE „ O i_, DUE TO CRASH ® ❑ 13-UNDER CARRIAGE 10 , 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76.TOP 3 _ El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S,_iL 6 4 COM VEH 0 Ea 1 0 ~ ELGIN N I L 60124 0 1 0 FIRST CONTACT 12 7 ; _5 *II Yes.See&debar U1 Z EV99296 IL 2026 REAR TELEPHONE IL D 4S4BP60C197341070 State Farm ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Goldenstein.Cynthia,J. 3573805SFP13 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI m x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 Dv !1 9 8 8 Freightliner Cd42.106 2023 00-NONE ,._"j 12..-_, DUE TO CRASH p ® 98 x o 13-UNDERCARRIAGE ta;l 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16•TOP 3 3 ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac on Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 I 4 COM VEH D ® Ut CO6 FIRST CONTACT 6 7A- -..-5 •If Yes.See Sidebar C Lombard IL 60148 0 1 0 P1196873 IL 2026 PEAR 0 Si) IL B 7 3ALACXFC1 PDNW0718 Zurich American Casualty ❑Y ®N RDEF XJ EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Lakeshore Recycling 0111154 09 ZAIC BAC E 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 ❑Y U2 Z N 1 ® 11 1 01 ,14 l2026 07 45 ®❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � o" 2 0 28 11 ) ! ❑PM, ❑Construction * R 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Goldentstein,Caleb,J. 11-601 298001351W ! ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility 45 t 2ARRESTNAMEAM 7 ❑pM Unknown work zone type U1 El 1 / ❑ ❑ n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 298-Lopez, Mirko 901 - r ! ❑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 INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C it, (example:shuttle or charter bus):or 0 g .. P,e,rrormnn.cr 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 < <.___A.._.� CIO & + : } } } transporting employee In the course of their employment(example:employee i transporter-usually a van type vehicle or passenger car):orco :�. < ...I. - 1* } } } •4. Is used or designated to transport between 9 and 15passen rs,includingthedriver, Not To Scale t for direct compensation(example:large van used for specific purpose):or __ _ i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m Iplacarding(example:placards will be displayed on the vehicle). XI —1 I CARRIER NAME Z - ADDRESS D (A Sh ,on9Pkwy. . i. i. 4. n CITY/STATE/ZIP g 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 . 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'; 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 ❑ 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 3 TOWED BY/TO. _Mies/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE