HomeMy WebLinkAbout2026-00014576 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 00111101001 IODU
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY ®5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 15
VEHICLE/PROPERTY El OVER$1,500
El NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00014576 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 f7
® ❑ RELATED PRIVATE ❑Y ®N 03 16 2026 ❑AM ❑YES E)NO U1 —<
S STATE ST Elgin mo /day/yr 12:23 ®PM FLOW CONDITION Ill
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010(t)!MI C)E S W LOCUSt St COUNTY PROPERTY El ® N DOORING Ely #OF MOTOR 0 SLOW 5 Cl)
Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD IN STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
/ / FOR DAMAGEDAREA(S) FROPtf TOWED U1 0
Unknown.O. Unknown Unknown 00-NONE EN
it.. 12 , OUETOCRASH ❑
NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 !!. 2 FIRE 0 IE <
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 M
SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3
9 9 ❑Y ❑N ❑UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value ALGN =
s 4 COM VEH 0 ZgJ
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF _,1[a !i,_ 1 00
~ 0 9 FIRST CONTACT 99 7_; _5 *IIYes.See Sidebar U1
REAR
2 Z ' E
TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 2
Unknown ❑Y ❑N U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same Unknown 3 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y El 99 0
g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 lily 0 Ncv ❑DV
/1 9 6 6 El Dorado MfgEZ!Ctder 2007 00-NONE i1_' t2 "_, DUE TO CRASH ❑ ! l 29 73
O Yr 13-UNDER CARRIAGE ( 2 FIRE ❑ ® U2 C
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M 2 4 ❑Y ❑N 0 UNK VEH. AT CRASH 99-UNKNOWN *OistractionValue 9 -
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8?A—I:.
COM VEH El U1 CO
CONTACT 1 O Y .5 •If Yes.See Sidebar
Z SOUTH ELGIN IL 60177 0 1 0 M172655 IL 0 I:EaR
M
IL A 7 1 N9MNAC637C084087 Exempt ❑Y ❑N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Pace Suburban Bus Di Exempt BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)1(TELEPHONE) (EMS) (HOSPITAL)
2 7 08 /
. DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 9 03,16 /2026 12 23 ®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 �
2 ❑ 04 18
N 3 0 0 CITATIONS ISSUED ❑PENDING 1 1 0 PM• El Construction
SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 5
—a, ARREST NAME / / El PM '
o N 1 ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT
30
t 2 ARREST NAME AM
7 1 / ❑❑PM 0 Unknown work zone type U1
El
OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 — ❑AM Workers present? ❑Y 30
345-Gomoll.Geoffrey 701 r / 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
ADDITIONAL UNITS FORMS.
. 0
r ----r••--, A CMV is defined as any motor vehicle used to transport passengers or property and: Z
Unit 2 I . g ore than pound { a p truck or truck trailer
u- I 1. Has a weight ratio m 10,000 5 ex m le:
r__--; ( combination):or
-<
I', INDICATE NORTH p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver
• - (example:shuttle or charter bus):or C
X
- L----------� r , r ,r } } } . transportinggemploo aeeslIn the coursee5 or fewer o their emrs ploymnd ent
xampd by a contract:employee carrier O
employees pbyment(example:employee X
' l transporter-usually a van type vehicle or passenger car):or co
L L.___a__ __ U_ � - 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver,
I nit t Polnt?o1?lnitlal?Contact } } } •
for direct compensation(example:large van used for speific purose):or 0
L L--_-a-___.I - l. i I i. 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 71
gplacarding(example:placards will be displayed on the vehicle). XI
g21.
— — — $ CARRIER NAME Pace Suburban Bus Division Z
Locust?Street y ADDRESS 550 ALGONQUIN RD
lmW—� I CITY/STATE/ZIP Arlington Heights 1 I L 160005 o+ i. i. i. i. MOTOR CARR.ID 0 Interstate El Intrastate
Not To Scale 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
----------1 - USDOT NO. ILCC NO. C
m
Source of above z
. -I
Were HAZMAT placards on vehicle? 0 Yes ® 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 ® 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?
❑ Yes II No ElUnknown 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 ®No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' m
TRAILER 1 ❑ ❑ 0 Z
ill
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Blue
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO:
_ . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE