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HomeMy WebLinkAbout2026-00009829 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 III1II MUH U �� IlU M MINN *1ffl1lI1UU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04146194 u, 1 U21 2 4 1 U1 3 U2 1 U, 1 u2 1 U, 1 U2 1 1 15 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S 0$501-51.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00009829 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 WING PARK BLVD Elgin 03: ® ❑ RELATED ®Y 0 N 02 19 2026 ❑AM ❑YES ®NO U1 -< 10 _ _ PRIVATE mo /day/yr NPM FLOW CONDITION MFT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY El ® N DOORING Ely #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD IN STOPPED U2 —I lgi 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!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 6 / yr 13-UNDER CARRIAGE 10.I 2 FIRE 0 N STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 Ea U2 0 171 M 2 4 SYTM❑Y NSNE EDUNK VEH. O AT CRASH 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it �i 4 COM VEH 0 Ea 1 n F. _FIRST CONTACT 11 7_ �_-6_;__5 *Ilves.See Sidebar U1 0 Z ELGIN IL 60123 0 1 0 FD11370 IL 2026 REAR TELEPHONE IL D JTDKB20U067074147 American Heartland Insura ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same ILA16000 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER yf 6 Hyundai Santa Fe 2023 00-NONE Q.i z j p DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE 10.j ©ll 2 FIRE ❑ N U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *0istrac ion Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 Il, COM VEH ❑ N U1 CO FIRST CONTACT 1 7�� -5 •If Yes.See Sidebar H ELGIN IL 60123 0 1 0 DY29828 IL 2026 I 0 M IL D 5NMS3DAJ8PH560101 Travelers ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Waslo. Diane. M. 6150862132031 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME!!(ADDRESS)!(TELEPHONE! (EMS) (HOSPITAL) 2 3 01 / U1 1 D / / 2 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 N 11 4 02/19 /2026 03 10 0 pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 0 23 99 / / ❑PM ❑Construction Z3 0 N CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 —a, ARREST NAME Wells.Arthur. L. 11-1204-B 1549-332 / / 0 PM o u 1 ® 11 4 �!CITATIONS ISSUED 0 PENDING UtilitySLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑ t 2 ❑ ARREST NAME Waslo,Scott.A. 6-101* 1549-333 021 19 /2026 03 16 N PM 0 Unknown work zone type U1 30 2 2 3 El CO ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1549-Brown. Bryan 600 337-Thompson 03 (09/2026 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 truckrtrailer -< i- }__-_r_-_-; I. combination):or INDICATE NORTH 51 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or Not To ScaleL. 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O T } } } } transporting employees in the course�of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or CO __ ...1. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C for direct compensation(example:large van used for specific purpose):or o L t - -i----i Unit2 - 4. < < < ,_ 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m I ( IT, i placarding(example:placards will be displayed on the vehicle). -1 I' 'I CARRIER NAME a WTHlphland4Ave Z ADDRESS D IV) w• CITY/STATE/ZIP O I N 5 't - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _ 4. - USDOT NO. ILCC NO. m XI Source of above Z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = 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?El❑ Yes II No 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 71 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' -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 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 NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE