HomeMy WebLinkAbout2026-00006815 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II 111 I M 111111111 I IlU II Iffiflhl WOOD
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004127046
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 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$1,500 El NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash
❑AMENDED YR 202612026-00006815 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I
® ❑ RELATED PRIVATE ❑Y ®N 02 04 2026 ❑AM ®YES 0 NO U1 -<
N RANDALL RD Elgin mo /day/yr 04:05 ®PM FLOW CONDITION ITT
•
2313C0!MI O E S W Fletcher Dr COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 1 C/)
Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
183 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C)
0 7 /
yr 13-UNDER CARRIAGE 10 l 2 , 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ]$I U2 2 rn
M 2 5 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ;il_6 I,.4 COM VEH ❑ Ea 1 0
~ ELGIN N I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *Irves.See Sidebar U1
Z 4072244B IL 2026 REAR
TELEPHONE
UNK. Other 0 4TANL42N7TZ163706 American Alliance ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same ILAA110727400 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y ® N 2 eu
m x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 lily 0 NOV 0 Dv
Yr/1 9 9 8 Ford Fusion 2008 00-NONE ,�_"j Qi-_, DUE TO CRASH ❑ (� 2
0 13-UNDER CARRIAGE 16/ 1. 2 FIRE ❑ ® U2 C
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 g
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 6 NT OF Y II"Q1-__5 C•IOMs gee SidebarH ® in CO
H C
ELGIN IL 60123 0 1 0 FZ87380 IL 2026 REARg Sn
M
IL D 0 3FAHP08108R262050 Safeway ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 38252011LPP007 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
3 3 02 / M 2 4 0 1 0
m
/ / #OCCS D
Xl
/ / U1 1 D
/ / 1 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 21 ,12 /26 04 05 ®AM in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
2 0 03 99 21 ,12 /26 04 10 ®PM ❑Construction *
0G
<w 3 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME J
❑AM ❑Maintenance U2
-, 1 ® 11 1 ARREST NAME Lopez Utuy.Juan.O. 11-601 1530000605 21 /12 /26 04 14 ®pm• • El Utility SLMT
j$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
p N 0
AM 50
t 2 ❑ ARREST NAME Lopez Utuy.Juan.O. 6-101-A 1530000606 21 ,12 /26 04 22 ®PM ❑Unknown work zone type U1
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 50
1530-Soto.Oscar 981 320-Cox 31 , 12 ,26 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
0 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 -<
----;-----; Not To Scale , ( INDICATE NORTH combination):or -I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
_ (example:shuttle or charter bus):or 0
I I r 3. Is designed to carry15 or fewer passengers and operated a contract carrier O
----A----1 a {
tl } } } transporting employee In the course of their employment(example:employee
y a van type
CD
C
< <.___a____� 3 . } 4alsuosedordrter- estlnatedto transport betweeicle or n9 and r15r) ssen rs,including[hedriver,
} } for direct compensation(examp large van used for specific purpose):or
t � t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires 'D
placarding(example:placards will be displayed on the vehicle). XI
—1
CARRIER NAME Z
I.r - ADDRESS D
I CITY/STATE/ZIP n
u-�i - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I r �l 0 O
Not in Comm./Govt. Not in Comm./Other
IUntt3
USDOT NO. ILCC NO. C
m
N?Randall?Rd 73
Source of above z
'
. IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
—' TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
a
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
Red White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/Impound Lot Garage . 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