HomeMy WebLinkAbout2026-00009490 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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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 ❑5501-51.500 ®ON SCENE 3
VEHICLE/PROPERTY ElOVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
El AMENDED
YR 202612026-00009490 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 6 "n
TOLLGATE RD Elgin
® ❑ RELATED ❑Y ®N 02 18 2026 ®AM ❑YES ®NO U1 —<
PRIVATE mo /day/yr 06:41 ❑PM FLOW CONDITION m
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®25 ®!MI N OE S W STATE St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR SLOW 6 Cl)
Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD DOSTOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O
gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0
0 9 /
yr FIRE ❑ IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U C)DISTRACTED ID U2 6 m
M 9 SY4 ❑Y ®SNE M DUNK VEH. AT CRASH IN n D 99-UNKNOWN 9 76•TOP 3 *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR
F. POINT OF $ 1 a �i 4 COM VEH 0 Ea 1 0
FIRST CONTACT 1 7 --. _;__5 *IIYes.See Sidebar U1
Z CHICAGO IL 60636 A 1 0 217369H IL 2026 r'�'4R
TELEPHONE
IL C 1 FDUF5GT7RED05598 GRANGE INDEMNITY INS.CO. ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire M M K EXPORTS CA2870281 2 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
99
g DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 iv 0 DV
1 9 9 1 Mack Trucks. !Garbage Truck 2018 oo-NONE O, 12.._, DUE TO CRASH ❑ ® 98 x
0 Yr 13-UNDER CARRIAGE o E FIRE ❑ ® U2 C
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M 9 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16_TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value U1 0
POINT OF 8 i 4 COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1 C
FIRST CONTACT 11 7 _5 •If Yes.See Sidebar
Z AURORA IL 60506 0 1 0 56502R IL 2026 I 0 Si)
IL A 7 1 M2AV17C1JMO12093 ACE AMERICAN INS.CO. ❑Y ®N RDEF XJ
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
WASTE MANAGEMENT OF MMTH11435154 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)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 02,18 /2026 06 41 ®❑AM
in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 �
2 ❑ 18 99
N 3 ❑ ❑CITATIONS ISSUED 0 PENDING + ) - 0 PM- ❑Construction
SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7
—a, ARREST NAME ! r ID PM '
o N ® 11 1 •
0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility SLMT
t 2 ❑ ARREST NAMEAM
x- 7 1 / ❑❑PM 0 Unknown work zone type U1
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 - ❑AM Workers present? 0 Y 30
244 Blomberg. Michael 501 , ❑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
w-1) I I 1 I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
` --I--I- -- ' -- --' � I I I - I. INDICATE NORTH combination):or -I
SIB7N78mte78r I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
_ I4o1'rro7tiaaN J I I I I } (example:shuttle or charter bus):or 0
I u,,,,,� designed carry passengers and operated by a contract carrier I O
3. Is des ned to 15 or fewer
I - } I } transporting employees In the course of their employment(example:employee
� transporter-usually a van type vehicle or passenger car):or C
I. L.___a____JZ.-------. , —.:, unit' 4. Is used ordesi natedtotrans rt between 9 and 15passengers,includingthedriver,
t } } for direct compensation(examp large van used for speific purose):or
I. I_ ..I.. _I t :. t 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires
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placarding(example:placards will be displayed on the vehicle). ;p
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7tllgata7Rd I I-- I- , CARRIER NAME Z
ADDRESS 0
T.
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CICITY/STATE/ZIPC)g
NIBM?Statent - MOTOR CARR.ID 0 Interstate 0 Intrastate
❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
--- --1 - USDOT NO. ILCC NO. C
m
XI
Source of above z
. 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
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
White Greenw
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO.
SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 DUETO TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® Other/Unknown VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE