HomeMy WebLinkAbout2026-00014533 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets 01111101111 1001111010000 I 0
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004178841
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INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 3
VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 202612026-00014533 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 7 m
ROUTE 20 HWY Elgin
® ❑ RELATED ❑Y ®N 03 16 2026 ®AM ❑YES ®NO U1 -<
PRIVATE mo /day/yr 07:28 ❑PM FLOW CONDITION m
_
®75 ®/MI N OE S W Randall Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Ig DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
Pekuraru.Vladyslav 0 7 /
yr 13-UNDER CARRIAGE ! NI
101 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 U2 4 <<
]$I Tl
M 2 4 ❑Y SYSTEM IN ENGAGED (i� OTHER 9 16.70P 3 _
ID N DUNK VEH. AT CRASH 9 UNKNOWN `Distraction Value ALGN
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ;i�6 4 COM VEH ❑ j$J I 0
f. FIRST CONTACT 15 7 ;-, _5 *II Yes.See&debar U1
V Z Arlington Heights IL 60004 0 1 0 P1334743 IL 2026 REAR
TELEPHONE
IL A 7 4V4NC9EHXRN642245 Acord El igiJ N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
M LK Enterprises LTD. TI NCA7505947-25 3 m
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER >
Refused ❑Y ® N 21 (,�j
g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0!My 0 NCv 0 DV
/1 9 y 9 1 Toyota Camry 2007 00-NONE ,1_' t2 _, DUE TO CRASH ❑ (� 2 x
o — 13-UNDER CARRIAGE 10/ 2 FIRE ❑ ® U2 C
c
M 2 4 SYSTEM IN ENGAGED 15-OTHER 016.70P 3 0 X
❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF I 6 i!,_ COM VEH D ® U1 W
I— FIRST CONTACT 9 7 _,L_5 •If Yes.See Sidebar C
E LG I N IL 60120 B 1 0 DF43042 IL 2027 I Si)0
Z
IL D 4T1 BK46K97U531344 Progressive ❑Y ®N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire Same 984364578 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 3/ /61 /026 07 28 0 AM Ei in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C)
2 20 28 3/ /9/ /026 07 47 ❑PM 0 Construction
*
R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVE° TIME 7
z J ®AM ❑Maintenance U2
o 1El 11 1 ARREST NAME Pekuraru,Vladyslav 11-709-A 298001368W 3/ /9/ /026 07 50 ❑PM SLMT
❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o N ❑Utility
AM U, 55
Ti 2 ❑ ARREST NAME 3/ /9/ /026 08 09 0 PM El Unknown work zone type
D'_
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ ❑AM Workers present? ❑Y 55
298-Lopez, Mirko 702 - / / ❑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
Randall?Rd. 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
` ` --I -' r INDICATE NORTH combination):or .Z-1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ i. - i. (example:shuttle or charter bus):or 0
L A I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
} } } transporting employees In the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or CO
L L.___a__..� 4. Is used ordesi natedtotrans rt between 9 and 15passengers,includingthedrrver,
I I A ' al t } for direct compensation(example:large van used for speific purose):or
-U
L L____a____ ,cr t i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
_ placarding(example:placards will be displayed on the vehicle). XI
t •" Not To Scale __
_ CARRIER NAME Z
,° __ ADDRESS
w
CITY/STATE/ZIP g
j - i. i. 1i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5
I I I
❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
�" - - USDOT NO. ILCC NO. m
XI
Source of above z
. ❑ Yes II 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
White White
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: 2 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE