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HomeMy WebLinkAbout2026-00008031 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III 11 IIII UH U l IlU fl fl11flUU111I�U DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00413803>t u, 1 U21 3 4 1 Ut 5 U2 1 U1 1 U2 1 U1 1 U2 1 1 10 U1 2 U2 3 *P0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and for Tow Due To Crash YR 202612026-00008031 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 02 11 2026 ®AM ❑YES ®NO U1 -< W CHICAGO ST Elgin07:38 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION Ill FT!MI N E S W N STATE ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO U2 --I Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n rar TOWED U1 Q Camargo. Luis.A. Infiniti M35X 2009 00-NONE , 12 , DUE TO CRASH ❑ ® E C NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©,I I�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 4 rn M I 2 SYTM IN ENGAGETHER 4 ❑Y ®SNE El UNK VEH. 0 AT CRASH 0 99-U15-UNKNOWN 9 16•TOP 3 `Distraction value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it 6 �i 4 COM VEH ❑ 0 1 0 ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; __5 *II Yes.See Sidebar U1 Z EU68757 IL 2026 REAR TELEPHONE IL D J N KCY01 F09M851633 State Farm ❑Y J N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 0104756-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y El 2 c �{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 row 0 NCv 0 DV yr 12 o 13-UNDER CARRIAGE 1a� 2 FIRE ❑ ❑ U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iI 4--I 6 1'',_ COM VEH ❑ ® U1 CO FIRST CONTACT 1 Y._,j_,__5 •If Yes,See Sidebar C — West Dundee IL 60118 0 1 0 FP44039 IL 2026 REAR0 IL D 1 FTEX1 C55KKD47832 Georgia Fleet Insurance ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Nicor Gas EN4CA00467-251 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (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 ® 11 1 02,11 /2026 07 38 ®❑pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 ❑ 04 26 N 1 3 ❑ 0 CITATIONS ISSUED CI PENDING + / 0 PM- El Construction SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 —a, ARREST NAME ! / ID PM ' o N 1 ® 11 1 • 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility SLMT r 2 ❑ ARREST NAME AM x- 7 1 1 ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 30 1505-Caliendo.Anthony 601 / / ❑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. .. .. , I i A CMV is defined as any motor vehicle used to transport passengers or property and: Z r r , 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ' } ' ' I - } INDICATE NORTH 0 combination)or BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C L - } (example:shuttle or charter bus):or Co 0 °� 3. Is designed to carry15 or fewer passengers and operated a contract carrier O - - -- i tea • } } } transporting employee In the course of their employment(example:employee I ° / i' 4 transporter-usually a van type vehicle or passenger car):or co i. <____A ...I. I $,-t) G I W?Chlcago?St. _ 4. Is used or designated natedtotrans rtbetween9and15 N ° VI. t } } for direct compensation(example:large van used for specific purpose):ording the diver, Go. ,� ' N 0 < i..._.a....� f;; �_. } } } t 5. Is an vehicle used to transport any hazardous material(HAZMAT)that requires �`'� placarding(example:placards will be displayed on the vehicle). XI _�I D CARRIER NAME Z Z ADDRESS 0 w • CITY/STATE/ZIP n _ i. i. i. i. 4. MOTOR CARR.ID 0 Interstate ❑ Intrastate I I . I i 0 Not in Comm./Govt. Not in Comm./Other I ‘I. I N USDOT NO. ILCC NO. mI Not To Scate_f 73 Source of above z . 0 Yes II No ❑ Unknown A 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'; ❑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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Blue White 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE