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HomeMy WebLinkAbout2026-00011601 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10011110 OH I 000111100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004152119* u, 9 u21 1 1 1 U, 8 U2 1 U1 99 1_12 1 U,99 U2 1 1 12 u, 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00011601 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ® ❑ RELATED ❑Y ®N 02 28 2026 ❑AM ❑YES ® PRIVATE NO U1 S RANDALL RD Elgin mo /day/yr 06:43 ®PM FLOW CONDITION m �O C7!MI O E S W Bowes Rd COUNTY PROPERTY El ® N DOORING ICIv #OF MOTOR 0 SLOW 1 cn Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 NV., 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 3 0NT yr Unknown Unknown NONE ©, 12 , OD DUE TO CRASH ❑ EN 13-UNDER CARRIAGE } I� FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) . 2 SYSTEM IN ENGAGED 15-OTHER 9 76.TOP 3 DISTRACTED 0 0 U2 3 MF 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Vatuc ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 li,4 COM VEH 0 Ea 2 O F- 0 9 0 FIRST CONTACT 1 7_;mai -5 *lI Yes.See Sidebar Ut 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 2 111 I— Unknown ❑Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 99 GX) m x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 i uiv 0 v ❑Dv yr 1O j t2 c. 2 FIRE 0 ® U2 C 0 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN O *Oistract n Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- 1. 6 I i, 4 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 3 7��'—_,SOS *If Yes.See Sidebar ELGIN IL 60123 0 1 0 CE86969 IL 2026 REAR 0 IL D 5YJ3E1 EB9SF960792 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 999391862 BAc $ 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)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 9 02,28 ,2026 06 43 ®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 � 2 0 20 99 N 3 ❑ ❑CITATIONS ISSUED 0 PENDING + ❑PM• El Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 5 —a, ARREST NAME / / ID PM ' o N 1 ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT ❑ 50 t 2 El ARREST NAME AM 7 1 r ❑PM El Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1531-SchEmbach.Jack 801 269-Mendiola , / ❑❑PnMn Workers present? ®N U2 50 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••--, , -I I I I - A CMV is defined as any motor vehicle used to transport passengers or property and: X. ��_. I I 0 01. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }--_-r-_--; § yr,i-° lllvvv - or —I} combination): : INDICATE NORTH p1 I 'II I I _ Not TO Scale BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Ra Idell7 Id r r (example:shuttle or charter bus):or C L AI I } 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } transporting employees in the course of their employment(example:employee X I • transporter-usually a van type vehicle or passenger car):or w L L.___a____� 4. Is used ordesi natedtotrans transport passengers,including N , } } } g po specific p rs,includi the driver, ---; I I I for direct compensation(example:large van used fors cific purpose):or O L L..__a_ - i i _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires rn Iplacarding(example:placards will be displayed on the vehicle). ;p - ` CARRIER NAME Z _ _ _ ADDRESS 0 Bawes7Rd T. I I I CITY/STATE I C) ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I I I ❑ Not in Comm./Govt. 0 Not in Comm./Other -"--------1 - USDOT NO. ILCC NO. rn xi Source of above z ❑ Yes ❑ No 0 Unknown 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 ❑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 Gray 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/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE