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HomeMy WebLinkAbout2026-00012324 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets 01111101111 0 lUll 01000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X304155460' u, 1 U21 3 4 2 U, 7 U2 1 U, 1 1_12 1 U1 1 U2 1 4 11 U1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ❑ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ®NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00012324 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 03 03 2026 DAM ❑YES ®NO U1 —< N RANDALL RD Elgin06:45 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 ' ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRO t TOWED U1 Q N u en. Dieu.V. 0 5 / yr 13-UNDER CARRIAGE ©,I :: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 SYTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN ENGAGED 0 99-UNKNOWN 9 16•TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it 6 4 COM VEH ❑ j$J 1 0 ~ ELGIN N I L 60123 0 1 0 FIRST CONTACT 12 7_;1 __5 *Yves.See Sidebar U1 Z V201816 IL 2027 REAR TELEPHONE IL D 4T1 BF1 FK9EU345190 Illinois Insurance Club ❑Y igi N U2 ni IS EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same AUT700846671 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 c p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 INv 0 NOV 0 DV !1 9 6 9 Cadillac Escalade 2025 00-NONE 'o,1 t2 c,�2 FIRE DUE O CRASH 0 ® U2 2 C o Yr 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraglon Value 9 U1 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 6 .I. 4 COM VEH ❑ ® CO H FIRST CONTACT 6 O7 a_Q-)OS •If Yes,See Sidebar C Z Gilberts IL 60136 0 1 0 FD74603 IL 2026aR 0 Si) M IL D 1 GYS9G RLOSR318469 Country Financial ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = ACAR Leasing LTD LSR PO109022246 BAC E 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 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z u 1 ® 11 1 31 r 12 /26 06 45 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) Oi 2 ❑ 03 99 N 3 ❑ ❑CITATIONS ISSUED 0 PENDING / / 0 PM- El Construction SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 —a, ARREST NAME / / El PM ' oN El 11 1 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT t 2 El 45 NAMEAM x- T r / ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 566-Lopez, Eric 602 320-Cox r / ❑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. .. .. , A CMV is defined as any motor vehicle used to transport passengers or property and: Z }-- -r- --, r r , N 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< r combination):or Z r- - - INDICATE NORTH p1 � J BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver _ (example:shuttle or charter bus):or X L A I I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w LII4. Is used or designated to transport between 9 and 15 passengers,includingN -- -- - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or o __ __ J I I • I 1AD I i. < L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m !___ placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME —I Z ^_______Th i ADDRESS o I T. I . . -.- . ! 1.- . . . . ... CCITY/STATE/ZIPOg MOTOR CARR.ID 0 Interstate 0 Intrastate ' Not To Scale J 0 Not in Comm./Govt. 0 Not in Comm./Other 00 �"-------1 USDOT NO. ILCC NO. m m x 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 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 Gray Red 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE