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HomeMy WebLinkAbout2026-00015783 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 1111011011 0100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0 1t9605 u, 9 u21 2 4 1 U,99 U2 1 U199 u2 1 U199 U2 1 1 10 U1 1 U2 3 *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 1215501-$1.500 0 ON SCENE 14 VEHICLE/PROPERTY ❑OVER$1,500 ®NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and f or Tow Due To Crash YR 202612026-00015783 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 03 22 2026 ®AM ❑YES ®NO U1 -< SOUTH ST Elgin11:10 g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT N E S W S EDISON AVE COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 / / T FOR DAMAGEDAREA(S) FROM�TOWED U1 0 Unknown.0. Unknown Unknown 00-NONE ©, > EN 2 �/DUE TOCRASH ❑ NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 1U 1 2• FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 8 m SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 M 9 9 ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = s 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,Ii_6 II,_ 1 I- 0 9 FIRST CONTACT 7_; COM VEH ❑ ZgJ 99 _5 *IIYes.See&debar U1 0 REAR 2 Z ' E TELEPHONE UNK. Other 9 Unknown ❑Y ❑N U2 I- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ❑ N 99 0 §, x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 Ncv 0 Dv yr!1 9 y6r 9 Honda CRV 2019 00-NONE 012.._, DUE TO CRASH ❑ 2 x o 13-UNDER CARRIAGE 10 1 c. 2 FIRE ❑ ElU2 C ll F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y lYiN ❑UNK VEH. AT CRASH 99-UNKNOWN *0istractionValue g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 ll, COM VEH D ® U1 CO FIRST CONTACT 1 Y _, _5 •(ryes,See SidebarC F- . . ELGIN IL 60123 0 1 0 ER68199 IL 2017 REAR 0 IL D 0 V3CZRU6H58KM734717 State Farm ❑y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 2865966-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER®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(22 l2026 11 10 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 28 18 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING ( 1 ❑PM• 0 Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME / / ❑PM ' o N ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT 30 t 2 0 ARREST NAME AM 7 ( r ❑❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 30 447-Collins, Dominique 601 - ( ! ❑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 3.W-dia°"'n'"* 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ' ' 0 r INDICATE NORTH combination):or p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n C nanases�a - } (example:shuttle or charter bus):or X A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O I. } } transporting employees In the course of their employment(example:employee X I transporter-usually a van type vehicle or passenger car):or W TC -- -- - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. to T for direct compensation(example:large van used for specific purpose):or O �4 _ -u L____a____. ' _ i L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires " m :o, placarding(example:placards will be isplayed on the vehicle). ;p t . 1 I f CARRIER NAME Z r % ' ADDRESS 'n ' D c) CITY/STATE/ZIP g i . - 4. MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __., - USDOT NO. ILCC NO. m Xl Source of above z IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = TRAILER VIM 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 Gray 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE