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HomeMy WebLinkAbout2026-00009855 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I00111101100 10111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X�6Ci4145542 u, 1 U21 2 4 1 u1 2 U2 1 u, 1 1_12 1 u, 1 U2 1 4 15 u1 1 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00009855 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �l N SPRING ST El In 06:06 ® ❑ RELATED ®Y 0 N 02 19 2026 ❑AM YES ®NO U1 -< _ _ g PRIVATE mo r day/yr ®PM FLOW CONDITION ITl FT!MI N E S W SUMMIT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 3 Cl) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NIA/ ❑icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 4 n 0 1 FOR DAMAGEDAREA(S) FRO T TOWED U1 O / / Kia Motors Co Iluride 2024 00-NONE ©, >2 0 DUE TOCRASH ® ❑ NAME(LAST,FIRST,M) Bernstein.Sheldon mo yr 13-UNDER CARRIAGE 10 1 2 FIRE ❑ tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 <<Tf M 2 8 SYTM❑Y OS NE❑UNK VEH. O ATCRASHD 0 15-99-UUNKNOWN THER9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 ',.4 COM VEH 0 E! 1 0 ~ Harwood Heights IL 60706 0 1 0 FIRST CONTACT 12 7_: __5 *uves.See Sidebar U1 Z 9MMB15 IL 2026 REAR TELEPHONE IL D 0 5XYP3DGC7RG533483 Geico ❑Y ®N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 6062 99 31 23 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 2 eu p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑Ialy 0 i v 0 Dv 1 9 yr 4 Honda Odyssey 2013 00-NONE 'o,��12 :_y FIREo CRASH ® U2 2 C 0 13-UNDER CARRIAGE IIEl c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6•TOP®* X ❑Y NJ ❑UNK VEH. AT CRASH 99-UNKNOWN Oistracti n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- l 6 I• !( 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 7 .'_, -5 *It Yes.See Sidebar ELGIN IL 60120 0 1 0 E617990 IL 2027 REAR 0 N 4D IL D 0 5FNRL5H65DB034558 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 0359043-SFP-13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND O N u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 10 / F 2 4 0 1 0 m / / #OCCS D / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 21 r 91 r026 06 07 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 23 28 , , ❑PM ❑Construction >E 1 Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Bernstein.Sheldon 11-1204-B 476000440 r r ID PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 0 AM r 2 ❑ ARREST NAME 21 r 91 1026 06 48 ®PM ❑Unknown work zone type U1 3O 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 30 476-Ramos.Clarissa 102 320-Cox 31 , 71 ,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. 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-_--; combination):or INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C C-9)N - } (example:shuttle or charter bus):or r r r X i . 3. Is desgned to carry15 or fewer passengers and operated a contract carrier O < - -- i L., } } } transporting employee In the course of their employment(example:employee i. i. __}----; •— - } } } •transporter sed or des gnated to transport betweelly a van type vehicle or n 9 and 15 passengers,including the driver, I -.oa-Illl -- for direct compensation(example:large van used fors specific purose):or .... I ! t i } } 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires ill — placarding(example:placards will be displayed on the vehicle). XI . 1 _111 Not To Scale.. - CARRIER NAME Z 1 r ADDRESS 0 EJZIP �C) I - i. MOTOR CARR.ID 0 Interstate El Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . ❑ 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 TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Redmons/Owners Residence . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE