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HomeMy WebLinkAbout2026-00014566 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0 III II I 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0041758.62* u, 1 U21 3 3 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 1 *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 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202612026-00014566 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 03 16 2026 E�IAM ❑YES ®NO U1 -< S RANDALL RD Elgin11:11 _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W SOUTH ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 Co ❑ 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 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) FROM TOWED U1 0 Dahlquist. Robert. L. 0 1 / yr 13-UNDER CARRIAGE ©,I 0,:0 FIRE ❑ El < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16-TOPS _ El N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r 0 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 FIRST CONTACT 11 7_i�6 �i 4__5 *If Yes.See Sidebar U1 COM VEH 0 Ea 1 0 Norridge IL 60706 0 1 0 F718597 IL REAR 2 2 Z TELEPHONE IL D 4T1 B11 HK6KU241053 Allstate ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 947352698 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER Xl Refused 0 Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 MAV 0 e v 0 DV !1 9 y 8 5 Infiniti QX60 2019 00-NONE 0. Q!'-O DUE TO CRASH 0 D 2 x o 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C M 2 4 ❑Y El ❑ SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 0 X NDUNK VEH. AT CRASH 99-UNKNOWN `Distracion Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i1 4 FIRST CONTACT 12 7 B 1I COM VEH ❑ ® U1 CO!.6 •(ryes,See Sidebar H BLOOMINGDALE IL 60108 B 1 0 BE4393 IL REAR 0 IL A 7 3PCAJ5M37KF126797 State Farm ❑Y ®N RDEF XJ EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Accord Trucking Inc 1104364-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (boat (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(r(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m #occs y / ,, U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 CD 11 4 03,16 l2026 11 11 N AM 0 PM in a Work Zone? NJ DIRP > co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n o", T 2 0 2 99 + ! 0 PM- ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o1 ® 11 4 ARREST NAME Dahlquist. Robert. L. 11-902 345000287 / / El PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility t 2 ❑ ARREST NAMEAM T 1 / ❑❑PM 0 Unknown work zone type 45 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 45 345-Gomoll.Geoffrey 800 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. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z r I I el combination): r more than pounds(example:truck or truck/trailer` 1. Has a weight rating10 000 i -< INDICATE NORTH o p0 ` I - 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C \ (example:shuttle or charter bus):or n \\l r r0 ` o 3. Is designed to carry15 or fewer passengers and operated a contract carrier O �..._a_._.� m } } } transporting employee In the coursee of their employment(example:employee X Unit 2 I y I transporter-usually a van type vehicle or passenger car):or w 4. Is used or designated to transport between 9 and 15 passengers,including rCjt � }-----;----+ J �"�,r � - } } } g po passen rs,indudi the driver, 1i for direct compensation(example:large van used for specific purpose):or O ram.. L----a-___. •= • mivaIwarmaf?co ) - l. I I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires user — � placarding(example:placards will be displayed on the vehicle). XI —•tyrdt1 - -- sornh48treat CARRIER NAME Z — ADDRESS 03 w I f — CITY/STATE/ZIP g _ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate Not To Scale J ❑ Not in Comm./Govt. 0 Not in Comm./Other 0 ----------1 - USDOT NO. ILCC NO. C m XI Source of above z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Red Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. _Artier/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE