HomeMy WebLinkAbout2026-00007588 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11110 fl
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004134.538
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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 2
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00007588 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mPRESTON AVE Elgin
® ❑ RELATED ❑Y ®N 02 09 2026 ®AM ElYES ®NO U1 -<
PRIVATE mo /day/yr 08:02 ❑PM FLOW CONDITION m
E050 ® O COUNTY PROPERTY 0 Y ® N DOORING Ely #OF MOTOR 0 SLOW 3 Cl)
!MI N E s W Lincoln Ave WITH VEHICLES INVLD IN STOPPED U2 --I
El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑V ® N PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Ig:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑!CV ❑DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2
FOR DAMAGED AREA(S) FROM TOWED U1 0
NAME(LAST,FIRST,M) mo
/1 9 9 9 Dodge Ram 1500(pickup) 2020 00-NONE 11 . 12 DUE TOCRASH ® 0 13-UNDER CARRIAGE 1 ! FIRE ❑ tz
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O THERDISTRACTED 0 ]$I U2 2 m
M 2 4 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iI a �i 4 COM VEH 0 j$J 1 0
~ ELGIN I L 60120 0 1 0 FIRST CONTACT 1 7 ;- -_5 *IIYes.See Sidebar Ut
Z 2982057E IL 2026
TELEPHONE
IL D 0 1C6SRFFT2LN125048 Progressive ❑Y ®N U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Przeklasa,Adam,J. 986208719 1 1—
"6 HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2
m g DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES 0 i uv 0 NOV 0 Dv
/1 9 8 5 Honda Odyssey 2003 00-NONE 11_' 12.._, DUE TO CRASH rg ❑ 2
o 13-UNDER CARRIAGE 10 r. 2 FIRE ❑ ® U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016•TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value U1 3
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF �i S ��, 4 COM VEH ❑ ® CO
F,,, FIRST CONTACT 6 l:!�_{_DyOS •IfYes See Sidebar
ELGIN IL 60120 B 1 0 V146588 IL 2026 REAR Z
IL D 0 5FNRL189X3B135726 State Farm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire 99 9 Torres,Salvador 0439595-SFP-13 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOBI (SEXI {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 3 05 /
D
/ / 3 0
U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z
N 1 ® 11 1 21 /12 /26 08 02 ❑PM in a Work Zone? ®N DIRP D
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1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1
2 0 17 28 21 /12 /26 08 13 0 PM ❑Construction *
R 1 O 0 xi CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
3 ®AM ❑Maintenance U2
o ® 11 1 ARREST NAME Przeklasa, Nicholas,A. 11-601-Ax SO471-000580 2/ //2 /26 08 16 ❑pM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
AM U1 30
t 2 El ARREST NAME 2/ //2 /26 08 44 M PM El Unknown work zone type
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
471-Evans, Lakysha 201 31 / 01 /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.
0r ----r••--, , - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z
esn?Ave.
L Chf 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -<
i- }____r____i if
} INDICATE NORTH combination):or
- _
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
l +w, (example:shuttle or charter bus):or 0
Ill 0 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
I- -A- - I <
- } } } transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - } } g po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or
L L--_-a-- II t i ii. , 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m
rn
\I urea , . . . placarding(example:placards will be displayed on the vehicle). :t1
. 1
CARRIER NAME Z
ADDRESS 0
V)
Ji. 4. 0
. CITY/STATE/ZIP g
MOTOR CARR.ID ❑ Interstate ❑ Intrastate
�in4Ave. ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
USDOT NO. ILCC NO. m
Not To Scale f m
XI
Source of above z
❑ Yes 0 No 0 Unknown M
D
Did Carrier Safety Regulations MCS)violation contribute to the crash? A
❑ Yes No ❑ Unknown C
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
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LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 0 0 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Black White
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE