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HomeMy WebLinkAbout2026-00011146 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0011110 fl I II 1111 II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004152152' u, 1 U21 2 4 1 u, 5 U2 1 u, 1 u2 1 u, 1 U2 1 1 10 u, 3 U2 1 *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 ❑$501-$1.500 ®ON SCENE 8 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00011146 VEHT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 WALNUT AVE El In03:27 ® ❑ RELATED ®Y 0 N 02 26 2026 El— ❑YES ®NO U1 g PRIVATE mo !day/yr ®PM FLOW CONDITION ITl FT/MI N E S W VAN DALIA ST COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR NI SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 T TOWED U1 Q Smith.Albert. mo I. Ford Mustang 2003 00-NONE ©, 12 , DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE I FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 ]Si U2 2 171 M 2 4 SYTM❑Y ®SNE El UNK VEH. 0 AT CRASH 99-UUNKNOWN THER O9 16-TOP 3 *Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D;i�B 4 COM VEH 0 Ea 1 O I . ELGIN I L 60123 0 1 0 FIRST CONTACT 1 U 7 ; _-5 *If Yes.See Sidebar U1 Z FD11591 IL 2026 TELEPHONE IL D 0 1 FAFP44493F419935 Allstate ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 811772207 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEON. 0 EWES 0 New 0 NCV 0 DV !1 9 9 5 Kia Motors Co►peltos 2021 00-NONE 0. Q!•-O DUE TO CRASH ❑ 2 x o Yr 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:,-4 COMVEH ❑ ® U1 W FIRST CONTACT 12 7�_, .5 •(ryes.See Sidebar H ELGIN Z IL 60123 0 1 0 EA64500 IL 2026 M IL D 0 KNDEUCAA5R7489485 statefarm ❑Y ®N RDEF Xl EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 1 866068-SFP-1 3 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 01 / F 2 5 0 1 0 m / / #OCCS D / / U1 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 21 ,61 ,026 03 27 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 80 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 o" 2 0 28 06 , , ❑PM ❑Construction >F 4 Z 3 0 l� 3 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM El Maintenance U2 4 ARREST NAME Smith.Albert. I. 11-601 1556000170 , ! ❑PM 1 ® 11 4 0 CITATIONS ISSUED PENDING UtilitySLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ t 2 El ARREST NAME 21 +61 1026 04 20 ®PM 0 Unknown work zone type 0 AM U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1556-Sanchez.Jimena 701 269-Mendiola 41 , 12 ,26 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 -< INDICATE NORTH combination):or -I / ,,/ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver . C L Not To Scale (example:shuttle or charter bus):or 0 . . �__.. 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier i O - w...v.. i. } } } transporting employees in the course of their employment(example:employee X it transporter-usually a van type vehicle or passenger car):or w L ----------+ . __I ��- - } } 1- •4. Is used or designated to transport between 9 and 1 passengers,including the driver, C I ,ir.11 for direct compensation(example:large van used fors specific purpose):or O t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a \ i I placarding(example:placards will be displayed on the vehicle). m I - CARRIER NAME Z ADDRESS T. w.ar.va w I CITY/STATE/ZIP C MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;_----- --1 - USDOT NO. ILCC NO. m XI Source of above z • m 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. w White Black 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: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE