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HomeMy WebLinkAbout2026-00008775 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II III 11 IIIIII UH U l II1111 fl fl IHIU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04138O91 u, 1 U21 1 1 1 U116 U299 U113 1_12 1 u, 1 U2 1 4 9 u, 1 U221 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00008775 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I 919 W CHICAGO ST Elgin06:51 ® ❑ RELATED ❑Y ®N 02 14 2026 ❑AM ❑YES ®NO U1 —< _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 3 Cl) ❑ FT/MI NESW Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER t] PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 02 n 0 2 / yr 13-UNDER CARRIAGE ©I O; FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O DISTRACTED 0 0 U2 02 M M 2 SY 15-OTHER 5 ❑Y ON E❑UNK VEH. O AT CRASH M IN D O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 4 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ii_6 1, COM VEH 0 g! 1 0 F. Bartlett IL 60103 0 1 0 FIRST CONTACT 1 7_: __5 *lIVes.See Sidebar U1 Z ZX41791 IL 2026 REAR TELEPHONE IL D 0 4T3RWRFVOMUO36253 Mercury Insurance ❑Y Il N U2 19 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILAP0000034361 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 XI m p DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 IIIAV 0 NOV 0 DV yr 13-UNDER CARRIAGE �a;i• 2 FIRE ❑ ® U2 C Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR n SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 a ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value POINT OF S �"4 Ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 j. COM VEH ❑ ® CO F,,, FIRST CONTACT 6 O7 ):I-0_OS •If Yes.See Sidebar DR84779 IL 2026 156R0 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 2C4RC1 CG7NR152982 ACE American Ins Co. ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 GE HEALTHCARE LSE ISA H08889892 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)1(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 O EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2Z N 1 ® 18 1 02/14 /2026 06 51 ®AM in a Work Zone? ®N DIRP co I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 41 28 / / 0 PM ❑Construction * Z 3 0 Dyg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Halbmaier.Zachary.T. 11-708 1561-000233 / ! El PM SLMT j$I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑Utility t 2 El ARREST NAME Halbmaier.Zachary.T. 11-601-Ax 1561-000232 02/14 /2026 07 30 0 PM El Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1561-Saroyic• Mirko 601 337-Thompson 03 /03/2026 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••--, , • Not To Scale ; A CMV is defined as any motor vehicle used to transport passengers or property and: > ' ratingmore than pounds(example:truck or truckrtrailer 1. Has a weight 10,000 ' }---_r__--; I ( combination):or INDICATE NORTH pr BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n I- I- --I. — 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees in the course of their employment(example:employee X rter- y a van type L L.___a____� f I \ I�i 4alsuosedordestlnatedto transport betweeicle or n9 and r15r) ssen rs,indudingthedrrver, C } } for direct compensation(examp large van used for specific purpose):or L i t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). m 0 D r-= CARRIER NAME 1 Z ADDRESS 0 D to usaismagtopwast rCITY/STATE/ZIP n - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I 0 Not in Comm./Govt. 0 Not in Comm./Other 00 -"---- --1 - USDOT NO. ILCC NO. C m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White Gray 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE