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HomeMy WebLinkAbout2026-00015440 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ 01111101111 M001111011011 11III11011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00417586o u, 1 U21 1 1 1 u1 9 U2 1 U, 1 u2 1 u, 1 u2 1 1 15 U123 U211 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 7 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00015440 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mSUMMIT ST El in04:45 ® ❑ RELATED 0 Y ®N 03 20 2026 ❑AM ❑YES ®NO U1 —< g PRIVATE mo !day/yr ®PM FLOW CONDITION m 5 !MI N E s ShadyOaks Dr COUNTY PROPERTY ®Y ❑N DOORING ❑y #OF MOTOR ❑SLOW 15 u) © Cook 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 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 MUSS 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) 0 6 FOR DAMAGEDAREA(S) FROf'tr TOWED U1 Q NAME(LAST,FIRST.M) Ganassin. Kristina. L. mo HyundaiTucson 2022 00-NONE DUE TO CRASH 0/ / yr 11.. 12 EN E 13-UNDER CARRIAGE 10l 2 FIRE 0 IE •STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m F 2 SY 15-OTHER 4 ❑Y ON E❑UNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ i� s �r.4 COM VEH 0 j$J 1 n ~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 5 7 : _O •Ir Yes.See Sidebar U1 0 Z EC55163 IL 2026 REAR TELEPHONE IL D 0 5N MJ BCAE3N H 136012 Allstate ❑Y ®N U2 93 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 811292456 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER en Refused 0 Y ® N 2 0 x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 MAV 0 NCv 0 Dv Yr !1 9 9 4 Honda Pilot 2025 00-NONE 11_"j 12 -_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE 10'i 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9,16-TOP 3 9 0 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraellon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & 1 S l:; COM VEH ❑ ® Ut CO FIRST CONTACT 7 O7 ,�==Q�._5 •If Yes,See Sidebar ELGIN IL 60120 0 1 0 FH34269 IL 2026aR M IL D 0 SFNYG1 H79SB137531 USAA ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same USAA 033601670 7101 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 N 1 ® 11 5 03,20 /2026 04 45 ®pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 Eri 2 0 28 30 N 1 3 ❑ ❑CITATIONS ISSUED 0 PENDING + ❑PM• El Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 -a, ARREST NAME ! ! _ ID PM ' 1 ER11 5 ❑CITATIONS ISSUED ❑PENDING • UtilitySLMT ou SECTION CITATION NO. ROAD CLEARANCE TIME ❑ r 2 0 ARREST NAME 03 r 20 12026 04 45 ®PM El Unknown work zone type U1 0 AM 15 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ID1542-Chase. Ethan 201 - 1 ! ❑❑PM Workers present? ®N U2 15 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 truckrtrailer -< c ` --I -' r INDICATE NORTH combination):or -I lir—--1,11 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or 0 X I- I- --I-----J. �c w` - trans designed rti eploo aees1In he course of 5 or fewer he a mplanoyment employee a contract ner X 1 / ` I } r } transppoorterg-usually a van type vehicle or passenger car):(example:r L L. -__ a._ } 4. Is used ordesi nated to trans rt between 9 and 15passengers,includingthedriver, } } for direct compensation(example:large van used for speific purose):or L L--_-a-___. / - t i 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). J C ........... -- —1 CARRIER NAME Z ADDRESS 0tl D w c) CITY/STATE/ZIP g ® _.NOt TOSaars :() - MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . 0 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 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 Black Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE