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HomeMy WebLinkAbout2026-00008449 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0 1111 00 IOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004155445 u, 1 U2 3 4 1 UI 2 U2 U, 1 U2 U, 1 U2 5 6 U1 1 U2 *P 0119* 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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00008449 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 "I 343 S MCLEAN BLVD El In04:49 ® ❑ RELATED ❑Y ®N 02 13 2026 ®AM ❑YES ®NO U1 -< g PRIVATE mo /day/yr ❑PM FLOW CONDITION m _ COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW Cl) ❑ FT!MI N E S W Kane HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 ! ! FOR DAMAGEDAREA(S) FROM TOWED U1 Q Unknown Kia Motors Cof*edona 2023 00-NONE ©1 • ,z DUE TO CRASH ® ❑ 10 NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE .1 !:.O 2 FIRE ❑ alC STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 0-TOTAL(ALL) DISTRACTED ® 0 U2 DTI 9 9 SYSTEM IN 0 ENGAGED 0 15-OTHER 9t5-TOPO3 _ ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN Distraction Value 9 ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it s �1 O COM VEH 0 0 1 0 1- FIRST CONTACT 14 7__,,_ __145 'If Yes.See Sidebar Ut 0 2 Z 0 1 DU51383 IL 2025 REAR _ TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 5XYRLDLC8PG163947 unknown ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Negron.Angela. M. unknown 1 1- 5 HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER .5 RESPONDER ( ou ❑ DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 NOV 0 Dv yr 12 _ C1 o 13-UNDER CARRIAGE 10.i :., 2 FIRE ❑ ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 916-TOP 3 ❑ ❑ SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraellon Value U1 4 - POINT OF 8 - 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT Y —d:-5 C•IO e1sVSee •Sidebar❑ ❑ C CO F` ---, CO M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < RESP❑Y°❑N NDER U1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 W 01 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ❑ 1 3 KDOT Light Pole 02!13 /2026 04 49 ®❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ;, 2 ® 31 3 2EMAINST EAST DUNDEE 60118 18 18 ! ! 0 PM, ❑Construction * t Z3 0 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 -a, ARREST NAME / / ID PM ' o N 1 0 ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility SLMT t 2 ❑ ARREST NAMEAM T ! / PM 0 Unknown work zone type 30 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 2 3 0 ❑AM Workers present? 0 1514-Pratt.Tamera 701C 354-Mendiola ! ! ❑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 -< ` ` -' -' r INDICATE NORTH combination):or —I ;J BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t- (example:shuttle or charter bus):or 0 A m ,r 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O }____A____1 g --- _ i. } } } transportingemployeesinthecourseoftheirem ployment(example:employee .. transporter-usually a van type vehicle or passenger car):or w L +r 4. Is used or designated to transport between 9 and 15 passengers,including C}-----;----l. - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O L L____a____� _ l. i. i i ._ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires M << < < Q placarding(example:placards will be displayed on the vehicle). 1 uu,y'st CARRIER NAME Z *. o-w I ADDRESS 0 w CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate El Intrastate I . i pa+�+ ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 --- --; - USDOT NO. ILCC NO. C m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U_COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U_TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO:DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE