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HomeMy WebLinkAbout2026-00015325 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 M00111101011 1111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04176361 u, 9 U21 3 4 1 U1 7 U2 1 U1 99 1_12 1 1.11 1 U2 1 4 11 U1 11 U211 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00015325 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ❑ ® RELATED PRIVATE ❑Y ®N 03 20 2026 ®AM ❑YES ®NO U1 N STATE ST Elgin mo /day/yr 06:11 ❑PM FLOW CONDITION M_ _ 0.06 FT/8 ON E S W WING St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 7 Cl) Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD DO STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 03 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Campbell. Kenya.S. 0 8 / yr 13-UNDER CARRIAGE ©'I ©!m FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 0 U2 04 rC11 F 9 SY5 ❑Y ®SNEM❑UNK VEH. O AT CRASH O IN ENGAGED15-OTHER 99-UNKNOWN 9 16•TOP 3 *Detraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T_iL 6 4 COM VEH 0 Ea 1 0 ~ ELGIN N I L 60123 B 1 0 FIRST CONTACT 12 7_: __5 *Irves.See Sidebar Ut Z FB35836 IL 2026 REAR TELEPHONE KL4MMGSL4LB109098 NIA ❑Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same NIA 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER 'gD Y N 0 m g DRIVER IDPARKED ❑DRIVERLESS ❑ PEO ❑PEDAL 0 EWES ❑r My 0 KCv ❑DV /1 9 6 2 Cat Cyl 2022 00-NONE 1i_1 12"-_, DUE TO CRASH ❑ C 2 mo 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C Ti; M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 POINT OF9 8 I ' 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR - S �'_ COM VEH_{_ -5 debar •IfYes.SeeSi D ® U1 tC o I- WOODSTOCKZ IL 60098 0 1 P1039546 IL 2016 FIRST CONTACT 6 Y_i REAR WI D 1 K9SD2229NK226693 TRUMBULL ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 LIMA CONTRACTORS 83UEABE9WDW BAC $ HOSPITAL(TAKEN TO) RINCIDENT ESPONDER IF'Y' OWNER STREET,CITY,STATE,ZIP 996 A Refused ❑Y ®N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 03/20 /2026 06 11 gi 0 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 � o" 2 0 28 99 ! / ❑PM• 0 Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o 1 ® 11 1 ARREST NAME Campbell. Kenya.S. 11-601 1506-496 / / El PM SLMT I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 ' ❑Utility o N AM 30 T 2 0 ARREST NAME Campbell. Kenya.S. 3-707 1506-495 ! / PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1506-Nunez. Maria 501 04 , 14/2026 09 00 0 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 UNIT tl ADDITIONAL UNITS FORMS. r ----r••--, , ;�1 I I 0 A CMV is defined as any motor vehicle used to transport passengers or property and: Z ___ ___ r� P.O.I. HW To Scab _ 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ' ' ipil ) r INDICATE NORTH combination):or .Z-1 ' I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C �._ .4 - } (example:shuttle or charter bus):or f f T, K3 T Q 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O I- }-----I----1 k+ - } } . transportingemployees in the course of their employment pbyment(example:employee y k transporter-usually a van type vehicle or passenger car):or w L L.___a____� z I - . } . 4. Is used or designated to transport between9and15 ssen rs,includingthedriver, C for direct compensation(example:large van used fors specific purpose):or O i i 5. Is anyanydisplayed vehicle used to transport hazardous material(HAZMAT)that requires 71 WING?ST i placarding(example:placards( P will be dis la ed P Y on the vehicle M). m XI CARRIER NAME Z — — — — ADDRESS 0 w n CITY/STATE/ZIP g ' 1 MOTOR CARR.ID 0 Interstate 0 Intrastate I r I. I ❑ Not in Comm./Govt. Not in Comm./Other ; -- . ._ USDOT NO. ILCC NO. rn XI Source of above z . ❑ Yes 0 No ❑ Unknown A 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 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Orange u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Mies/Impound Lot Garage . 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