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HomeMy WebLinkAbout2026-00011660 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 I001111010 I III 101100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004167 a26 u, 1 U21 2 1 1 Ut 3 U2 1 U1 1 U2 1 U1 1 U2 1 2 15 U, 1 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El$500 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 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El Injury and f or Tow Due To Crash El AMENDED YR 202612026-00011660 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 m ® ❑ RELATED ®Y 0 N 03 01 2026 ®AM ❑YES ®NO U1 W CHICAGO ST Elgin 05:25 _ g PRIVATE mo !day,yr ❑PM FLOW CONDITION m FT!MI N E S W N U N I O N ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 cn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 02 mo 0 T�TOWED U1 Silvestri. Nicole. M. Scion TC 2014 00-NONE ©, >2• �/DUE TOCRASH ® ❑ NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE 10.I • 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 02 m F 2 SY4 ❑Y ONM❑UNK VEH. O AT CRASH IN O 15-OTHER 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il 6 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 . __5 *II Yes.See Sidebar U1 Z FT45262 IL 2026 E TELEPHONE IL D JTKJF5C77E3079562 American Alliance ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same I LAA-1111484-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 �{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv ❑Ncv ❑Dv 1 9 8 7 Ford Transit Connect 2019 00-NONE „ ` 12'"_, DUE TO CRASH rg ❑ 98 xi ... - 13-UNDER CARRIAGE FIRE 0 ® U2 c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 9 0 POINT OF s ( I 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 10 7Li 6 t .5 •IfYes.See Sidebar C z ELGIN IL 60123 0 1 0 4252147B IL 2026 I 0 fn IL D NMOLS7E24K1383963 NIA gly ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 CONSTRUCTION INC TOP NIA BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT( (DOB( (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / U1 1 D 1 0 U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z N 1 ® 11 1 31 ,12 ,26 05 25 ❑pM 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) Eri 2 ❑ 23 99 31 ,12 ,26 05 27 ❑PM ❑Construction E R 1 O ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ®AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Silvestri. Nicole. M. 11-601-Ax 1550-000248 31 ,12 r26 05 33 ❑PM• El Utility SLMT I$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 8 N ❑AM 30 t 2 El ARREST NAME Enriquez.Julio.C. 3-707 1550-000247 , r ❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1550-Camiacho.Oscar 601 41 , 41 ,026 01 30 ❑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 -< i- }---_r----; combination):or -I INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C N I (example:shuttle or charter bus):or k7ur / r r r 3. Is designed tocarry15 fewer passengers and operated a contract carrier 0 iili` eS or }. --I--' 'i - } } } transporting employees In the course of their employment(example:employee er d transporter-usually a van type vehicle or passenger car):or w 1 1 1 1 C i. }--- ----; - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, to _ for direct compensation(example:large van used for specific purpose):or %7CNnpo7w. li,_i1- L L--_-a-___. _ _ _ .,,� - - i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires III m placarding(example:placards will be displayed on the vehicle). ;p r ' CARRIER NAME Z , Z 1 ADDRESS r r -1- 1 . II irV) lVOt TO Scale I CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate El Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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 White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Police Department . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE