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HomeMy WebLinkAbout2026-00016474 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0 0111101000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X18176O u, 1 U21 1 1 1 U1 8 U2 1 U, 1 1_12 1 U, 1 U2 1 1 12 U1 18 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ®5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00016474 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED ❑Y ®N 03 25 2026 12,— ❑YES ElPRIVATE NO U1 S STATE ST Elgin mo /day/yr 06:32 ®PM FLOW CONDITION m 010(D!MI• O E S W Middle Rd/S.State St. COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 C) FRONT TOWED VI U1 0rooks.Cecilia. I. Audi Q5 2011 00-NONE ©, 12 _, DUE TO CRASH ❑ B NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE O '1 ! FIRE ❑ 1 < r1 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 ]$I U2 r F 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ®S NE❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i COM VEH 0 Ea 1 0 1 . ELGIN N I L 60120 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 Z FN36361 IL 2026 REAR TELEPHONE IL D 0 WA1 DKAFP2BA013538 Progressive ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 863635578 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NAV 0 NCV 0 Dv CIRCLE NUMBER(S) U1 1 9 9 3 Nissan Sentra 2015 00-NONE 11_"j 12..-_, DUE TO CRASH ❑ !1 2 x o 13-UNDER CARRIAGE 1 FIRE ❑ ® U2 c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOPO3 * X ❑Y NiN El UNK VEH. AT CRASH 99-UNKNOWN Oistraglon Value 0 POINT OF 8 i1 1I 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 2 Y _,__5 •IfYes.See Sidebar = Bartlett IL 60103 0 1 0 Q709797 IL 2026 I 0 IL C 0 3N 1 AB7AP7FY277040 Direct Auto ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Haikes. Margaret 203332850 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / ,, U1 1 D 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 03,25 ,2026 06 32 ®AM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 T 0 2 ❑ 2 99 + ) ❑PM• ❑Construction * R 3 ❑ 0 CITATIONS ISSUED 5 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Brooks.Cecilia. I. 11-601-Ax 1528-000354 / ! El PM SLMT S' N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility 0 AM T 2 El ARREST NAME 03125 r2026 06 40 0 PM El Unknown work zone type U1 40 2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? D Y 40 1528-Rivera. Kevin 701 269-Mendiola 04 ,27,2026 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 Z 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 -< i- }____r____1 I - INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i I _ (example:shuttle or charter bus):or urritra1 i 3. Is desgned to carry 15 or fewer passengers and operated �rated a contract carrier O I- I- -A- --i - } } } transporting employees in the course of their employment(example:employee � 73 ir° transporter-usually a van type vehicle or passenger car):or CO L }-----}----; I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or O L L--_-a-...� Z t i i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m,Zt —1 CARRIER NAME Z ADDRESS 0 T. M iddle9Rd w CITY/STATE/ZIP C)0 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other T � OC) ---- - Not To scare 1 USDOT NO. ILCC NO. m m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Silver 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: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE