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HomeMy WebLinkAbout2026-00008333 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10011110 fl11 II fl 1111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004138 4-9 u, 1 U21 3 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 1 10 U, 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00008333 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 02 12 2026 ❑AM ®YES 0 NO U1 -< N MCLEAN BLVD Elgin 03:16 _ _ g PRIVATE mo /day/yr NPM FLOW CONDITION m FT!MI N E S W W H I G H LAN D AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ® STOPPED U2 --I Igi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FRONT TOWED U1 Q Krieman. Kame n. L. Dodge Avenger 2013 00-NONE 12 , OUE TO CRASH ® ❑ NAME(LAST,FIRST,M) ry mo yr 13-UNDER CARRIAGE ©i FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O " 2 DISTRACTED 0 0 U2 4 M F 2 SYTM IN ENGAGEDTHER 4 ❑Y NSNE❑UNK VEH. O AT CRASH O 99-U15-UNKNOWN 0916-TOP S `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 4 COM VEH 0 j$J 1 0 ~ ELGIN N I L 60123 C 1 0 FIRST CONTACT 10 7 ; _5 *IIYes.See Sidebar U1 Z FJ35198 IL 2026 REAR TELEPHONE IL D 1 C3CDZCB6DN662133 State Farm ❑Y Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same 2597389-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman 0 Y ® N 2 0 N DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMv 0 Ncv 0 Dv /1 9 5 6 Honda Ridgeline 2009 00-NONE 0. Q!'-O DUE TO CRASH rg ❑ 2 o _yr 13-UNDER CARRIAGE 10( ) 2 FIRE 0 N U2 C M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:,-4 COM VEH 0 N U1 CO FIRST CONTACT 12 7 .5 •If Yes.See Sidebar H ELGIN IL 60120 C 1 0 71917R-B IL 2026 I0 C M IL D 5FPYK16269B101366 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 2852926-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph RESPONDER U1 = (UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 Unknown. Unknown Hit house at 213 N Mclean 02,12 ,2026 03 16 ®AM in a Work Zone? NCI N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ;, 2 0 42 5 213 N MCLEAN BLVD ELGIN IL 60123 25 28 02,12 /2026 03 17 PM ® , ❑Construction >E , 4 R 3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 a ER 11 1 ARREST NAME Krieman. Kameryn. L. 11-601 1549-324 02/12/2026 03 22 ®PM ❑Utility SLMT l$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME NAM r 2 0 ARREST NAME Krieman. Kameryn. L. 11-306 1549-323 02/12 /2026 03 27 ®PM El Unknown work zone type U1 30 2 2 3 ID ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1549-Brown. Bryan 601 337-Thompson 03 , 10/2026 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. 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 -< i- �____r____1 2197N?Yctun INDICATE NORTH combination):or —I Not Tb Scale BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ` �,.� (example:shuttle or charter bus):or 0 Is designed tocarry 15 fewerco passengers their o operated a contract:ememployee O espa g pe - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L --------- y 4. Is used or desi nated to trans rt between 9 and 15 ge ng C} } for direct compensation(example:large van used for �cifice purpose):mdudi [he driver, . 1,,ks pe ( P 9 specific P pose):or L L--_-a-___� ®�� t i. i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p — ems — — D �— !i 'M •jil g` CARRIER NAME Z ADDRESS 0VY'.'FIIphlanQ?AYe I co CICITY/STATE/ZIPC)g MOTOR CARR.ID 0 Interstate ❑ Intrastate z O 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. XI XI Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El 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'; ❑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 ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White Silver 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 DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE