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HomeMy WebLinkAbout2026-00007046 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 I0011110 lifi I 111111 I II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 132363 u, 9 U29 2 4 1 u,99 U216 u,99 u2 1 u,99 U2 1 5 15 u, 1 u2 11 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ®5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00007046 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ® ❑ RELATED ❑Y ®N 02 05 2026 ❑AM ❑YES ® PRIVATENO U1 W HIGHLAND AVE 1 HAMILTON AVE Elgin mo /day/yr 07:07 ®PM FLOW CONDITION m 010 ®!MI N E S © W HIGHLAND AVE/HAMILTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O g 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 2 n FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q NAME(LAST,FIRST,M) Unknown.O. mo 1 yr Unknown Unknown 00-NONE „ O i-, DUE TO CRASH ❑ EN 13-UNDER CARRIAGE 10 ' 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m 9 SY 15-OTHER 9 ❑Y ONM DUNK VEH. 0 AT CRASH IN D 0 99-UNKNOWN 9 76•TOP 3 ,Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL a 4 COM VEH 0 Ea 1 0 ~ Unknown UnknowrUnknown 0 9 0 FIRST CONTACT 12 7_; _5 *uYes.SeeSidebar U1 Z UNKNOWN ' E TELEPHONE 9 UNKNOWN Unknown ❑Y 0 N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Unknown. Unknown Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER t Y°®N Ai m g DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy 0 i v 0 Dv yr ��112 c 2 FIRE El El U2 C o 13-UNDER CARRIAGE c F 2 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TtOPO3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN 0istraction Value g g POINT OF s-.;,• It_ COM VEH 4 U1 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR _�J 5 r_, • D ® W = ELGIN FIRST CONTACT 3 7 _5 (ryes,See Sidebar IL 60123 0 1 0 P353093 IL 2026 REAR IL D 0 KM8J33A40MU400956 State Farm ❑y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 1258718SFP13 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)((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 CD 11 1 02(05 /2026 07 07 ®PM AM in a Work Zone? NJ DIRP D co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 n T Eri 2 ❑ 2 99 ( ( ❑PM ❑Construction * Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 -a ARREST NAME / / El ' o N ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SIMT , 30 r 2 ARREST NAME AM T ( 1 ❑❑PM 0 Unknown work zone type U1 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 1524 Silva Jose 607 320-Cox ( / ❑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 combination):or -< ' I } INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n i_ .:.. -:. i I } (example:shuttle or charter bus):or X 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O }} } • transporting employees in the course of their employment(example:employee phbM7Aw. ' transporter-usually a van type vehicle or passenger car):or w L L.___a.. 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, — — — — — Pe ( P 9 Pe or o L t i. i i. _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m `----�`----. arras 1-�' •" - m placarding(example:placards will be displayed on the vehicle). XI > 1=,i CARRIER NAME —I Z Unm o ADDRESS Nsnllm CITY/STATE/ZIP rAAw. D 0 Not To Scale f MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. m XI Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑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 Red 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: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE