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HomeMy WebLinkAbout2026-00010666 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets III 11 IIII UH U� �� IlU I 1101 H IUIIDU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004148685 u, 1 U21 3 4 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 4 U2 4 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER 51,500 El NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00010866 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 '1 N RANDALL RD Elgin09:20 ® ❑ RELATED ' V 0 N 02 25 2026 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION MFT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 --I El 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 Icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T�TOWED U1 Q NAME(LAST,FIRST,M) WILLIAMS. DALEN. M. mo Dodge Caravan(incGrand)2017 00-NONE „' © a/DUETOCRASH ❑ EN 13-UNDER CARRIAGE 10 i , 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ❑ 0U2 4 I<11 M 2 4 SYTM❑Y ®SNE DUNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s :i1 6 �i,4 COM VEH ❑ Ea 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 1 7_; __5 *IIYes.See Sidebar U1 Z FL51116 IL 2026 E TELEPHONE IL D 0 2C4RDGCGXHR699281 United Security Insurance ❑Y J N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same ULV1218890-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 XI m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED CI PEDALi PEDAL 0 EWES ❑ v 0 v ❑DV !1 9 5 7 Jeep(after 196;)npass 2014 oo-NONE ,�_-1 t2..-_, DUE TO CRASH ❑ C 2 o 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF Si 6 ....4 COM VEH D ® U1 IN I— FIRST CONTACT 6 7A-�-"05 •If Yes.See Sidebar C ELGIN IL 60123 B 1 0 AT76868 IL 2026 RE 0 Si) Z IL D 0 1 C4NJDEB8ED910354 ALLSTATE ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Barreras. Linda. D. 979473045 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 07 / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 02,25 /2026 09 20 ®❑PM 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 0 2 ❑ 03 28 I ! ❑PM ❑Construction >E Z 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 a WILLIAMS. DALEN. M. 11-710-A 456-443(w) / ! El PM —, 1 ® 11 1 ARREST NAME ( ) _ o U 0 CITATIONS ISSUED ❑PENDING UtilitySLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ AM 45 r 2 El ARREST NAME 02 r 25 12026 09 20 MPM ❑Unknown work zone type u, , T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El ❑AM Workers present? ❑Y 45 456-Romalo.Carmine 901 - r r 0 PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z II 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ' ` --I -, I I r INDICATE NORTH combination):or -I N.9RendalllRd BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I I ® - (example:shuttle or charter bus):or n ' r rr I- I- --I-- 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees in the course of their employment(example:employee X y a van type i. ...I. .� I I re$, w.zr�nlmrtAre 1 1C transporter sedord�llnatedtotransehrtbetweeicle or n9andr15r) ssen rs,includingthedriver, to I. I. } for direct compensation(examp large van used for specific purpose):or O L -a-___. - t i. I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 1./ placarding(example:placards will be displayed on the vehicle). m,Zt — — — — — — — — - -- —I CARRIER NAME Z I I r ADDRESS D Not To Scale ( V1 I I 0 I I CITY/STATE/ZIP g _ i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 �I. ------1 - USDOT NO. ILCC NO. C m XI Source of above Z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown M 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE