Loading...
HomeMy WebLinkAbout2026-00010112 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II 1 HH 1111 II MUH U �� IlU I I OU M 11111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04145522- u, 1 U2 3 4 1 U, 4 U2 U, 1 U2 U, 1 U2 5 6 U199 U2 *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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00010112 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 ® ❑ RELATED PRIVATE ❑Y ®N 02 21 2026 ®AM El YES IX]NO U1 -< S RANDALL RD Elgin mo /day/yr 00:41 ❑PM FLOW CONDITION m _ 025 ®!MI N E OS W South Foothill Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW Cl) Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS O 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 C) FOR DAMAGEDAREA(S) FRO TOWED U1 0 Padilla. Ma D. 1 1 / yr 13-UNDER CARRIAGE ©,I 0,,:0 FIRE El 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m F 2 SY 15-OTHER 9 ❑Y ®SNE❑UNK VEH. O AT CRASIN H O 99-UNKNOWN 9 t6•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a 4 COM VEH 0 0 4 O F. FIRST CONTACT 12 7 ;—, _5 *Irves.See Sidebar U1 Z Aurora IL 60506 B 1 0 BB64313 IL 2027 REAR TELEPHONE IL D 4S4BSAFC3K3287762 Progressive ❑Y ®N U2 Mr- Ill 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same 931710093 1 r o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 ❑ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 yr 12 _ C1 o 13-UNDER CARRIAGE 10.i :., 2 FIRE 0 ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 ❑ ❑ SPDR O ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value U1 3 - POINT OF s-.;, 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT YA='+:- COM•I s.EH See •Sidebar❑ 0 C CO F` ----- co M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESP❑YD❑N NDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) n / / U2 r m Pj / / UI 1 D 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 43 3 02/21 /2026 00 42 ®❑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 03. 2 0 50 5 28 18 02,21 /2026 00 42 PM ❑ ❑Construction >F N 3 0 45 2 BI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME z J ®AM ❑Maintenance U2 -a, ARREST NAME Padilla. Mary. D. 11-601-Ax S1546-000097 02/21 /2026 00 49 ❑PM SLMT o U 1 ❑ -0 CITATIONS ISSUED �PENDING Utility SECTION CITATION NO. ROAD CLEARANCE TIME o N Ely AM u, 45 t 2 El ARREST NAME 02/21 /2026 01 31 i PM El Unknown work zone type n TIME OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE 2 3 ❑ ❑AM Workers present? ❑Y 1546-Ignacio. Patricia 801 407-Sproles 03 ,23/2026 01 30 ®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 truckrtrailer -< i- }____r__--; ` 1 } INDICATE NORTH combination):or p3 \ \ \ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C \ \ \ ��, (example:shuttle or charter bus):or I- } ---- J \ \ \ I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O . ti \ \ \ Not To Scale }} } transporting employees in the course of their employment(example:employee X 1 1 1 transporter-usually a van type vehicle or passenger car):or i.I I I I 1 1 1 C ---- ----; $ - • } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver• N .�• 1 for direct compensation(example:large van used for specific purpose):or �`... .... i1 L ,.____a____. i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires i \' 'D 1 1 y •� placarding(example:placards will be displayed on the vehicle). � 1 4 1 CARRIER NAME 1 ( 1 z l 1 l ADDRESST. O 1I 1 \\ : ::::: :._...._. w lI I 0 II I n ij59F CITY/STATE/ZIP g MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I . I ❑ 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 O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 TRAILER 2 ❑ 0 0 o u 1 COLOR U_COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ti DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U_DUE ETOO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO: DUE T VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE