HomeMy WebLinkAbout2026-00016353 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 181 79
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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 El$501-$1.500 ®ON SCENE 3
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00016353 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
N RANDALL RD Elgin 07:54
® ❑ RELATED ®Y 0 N 03 25 2026 ®AM YES ®NO U1 '<
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITI
FT!MI N E S W POINT BLVD COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR IR SLOW 1 (/)❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 0
FOR DAMAGEDAREA(S) FROM I�
LI N D. RACH E L.A. 1 0 /
yr Cgl
10 !. 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ❑ 0 U2 99 171
F 2 6 SYTM❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF it 6 ii,4 COM VEH 0 j$J 1 C)
H Z WEST DUNDEE IL 60118 0 1 0 FIRST CONTACT 8 ®_: __5 *If Yes.See Sidebar U1 0
1 HGCP263 IL 2026 REAR
TELEPHONE
IL D 0 1 HGCP26309A092421 PROGRESSIVE ❑Y ®N U2 I—
Ill13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 948267563 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER
� /1 9 9 3 Nissan Kicks 2019 00-NONE i1_"j Q�,-_, DUE TO CRASH p 2 x)
o Yr 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 9 0
i1�f N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 12 8 7 B 4 COM VEH
.5 •
CARPENTERSVILLE IL 60110 0 1 0 CB72812 IL 2026 I If Yes.See Sidebar❑ ® U1 CO
IL D 0 3N1CP5CU4KL471596 LIBERTY MUTUAL ❑Y 123 N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X
99 9 GRAF.TYLER A0V2435419587558 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL)
2 6 01 /
/ 02 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 03,25 /2026 07 56 ®❑pM in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
2 ❑ 25 28
N 3 ❑ ]$(CITATIONS ISSUED El PENDING + / ❑pM, ❑Construction >E
SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM El Maintenance U2
a LIND.D. RACHEL.A. 11-306 1559000130 / / PM '
-, ARREST NAME ❑
o U 1 ® 1 1 1 CITATIONS ISSUED 0PENDING • TIME ❑Utility SLMT
o NSECTION CITATION NO. ROAD CLEARANCE 0 AM 5O
t 2 El ARREST NAME LI N D. RACHEL.A. 11-601-Ax 1559000131 , / El Unknown work zone type U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 50
1559-Dave los.Yoana 502 04 ,21 ,2026 01 30 ®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
1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
c ` --I -' r INDICATE NORTH combination):or .Z-1
Nor To ainrcl BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} - - } (example:shuttle or charter bus):or
Randall I , oe, I %• 3. Is designed to carry15 or fewer passengers and operated a contract carrier
} } transporting employee in the course of their employment(example:employee
I I I NI } transporter-usually a van type vehicle or passenger car):or w
L L.___a__...I. `- 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C
��� I. } for direct compensation(example:large van used for specific purpose):or O
L L____a____.I =� L 5 Is an anyvehicle used to transport hazardous material(HAZMAT)that requires m
�� �_ placarding P placards P Y )
Wcartli (example: will be displayed ed on the vehicle
CARRIER NAME Z
I I - ADDRESS
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CITY/STATE/ZIP n
g
MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
;_...Y. ._.; - USDOT NO. ILCC NO. m
XI
Source of above z
. Form Number
m
Xl
IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
a
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 White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE