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HomeMy WebLinkAbout2026-00016395 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 8 Sheets 01111101111 10011110 101101011��N111 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X0041 82 7 42 u, 1 U2 1 1 1 U145 u2 U, 1 U2 U, 1 U2 1 6 U1 1 U2 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00016395 VEHT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I MCDONALD RD Elgin ® ❑ RELATED ❑Y ®N 03 25 2026 ®AM ❑YES IX]NO U1 —< PRIVATE mo /day/yr 11.53 ❑PM FLOW CONDITION m CO2Oq0!MI N E S ® COMM Rd COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW Cl) 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 Hi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) FROM TOWED U1 0 Porter.John.C. 1 0 / yr O3-UNDER CARRIAGE ©,I 0,: FIRE 0 I C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 m M 2 6 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 1 ALGN = ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r COM VEH ❑ El 4 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it ii,40 F- FIRST CONTACT 11 7_;i_-_-;__5 *lIYes.See Sidebar U1 0 Z SOUTH ELGIN IL 60177 B 1 0 1063879 IL REARTELEPHONE IL D 2GNALCEK8G6296773 State Farm ❑Y ®N U2 r B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 0801572-SFP-13 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 98 0 ❑ DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 NMV 0 Ncv 0 DV yr 12 _ C o 13-UNDER CARRIAGE 10' t, 2 FIRE ❑ ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP3 ❑ ❑ SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraci n Value U1 0 - POINT OF 8-.. 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT Y:='+.-9 COM•I sVEH •Sidebar❑ 0 C to F` pEAR` SeeC M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESP❑YD❑N NDER U1 = (UNIT) (SEAT) (DOS) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 / / U2 r m / / U1 1 D / / 0 EV MOST EVNT DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 1 3 Wray.Jean. M. Mailbox and post 03,25 /2026 11 53 ®❑pM AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 70 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ;, 2 ❑ 40 3 4351 MCDONALD RD ELGIN IL 60124 45 41 ! / ❑PM, ❑Construction * " 3 0 41 3 BI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME J U2 ARREST NAME Porter.John.C. ! , O PM ❑Maintenance SLMT 610.2 B 345000288 o N 1 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility MT 45 t 2 ARREST NAME AM cf 7 ! r ❑❑PM ❑Unknown work zone type U1 El n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ❑Y AM Workers present? 2 3 ❑ ® 345-Gomoll.Geoffrey 801 04 , 14/2026 09 00 ❑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 -< ` ` ' ' ( N ) r INDICATE NORTH �mb rtatbn)or p3 r BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or 0 < <---- -•-•; transporting employeened to s 5 or fewer Inthe course passengers rhea emand ployment operated xample:employee transporter X } F vn'v transporter-usually a van type vehicle or passenger car):or co -- -- �oond'�"i^'ra°i^� _ } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C for direct compensation(example:large van used for specific purpose):or_ __ �� O _ _ i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m e / placarding(example:placards will be displayed on the vehicle). X/ . . . . il -1 CARRIER NAME Z ADDRESS 0 / C CITY/STATE/ZIP 0 0 Not To Scale I - MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 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 0 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? A ❑ Yes II El Unknown C 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_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 3 TOWED BY/TO. _Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U_DUE ETOO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO: DUE T VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE