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HomeMy WebLinkAbout2026-00017226 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets MI1111111111111 111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04185t17- u, 1 U21 2 4 1 u, 2 U2 1 u, 1 u2 1 u, 1 U2 1 5 15 u1 1 u2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00017226 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m WING PARK BLVD Elgin08:15 ® ❑ RELATED ®Y ❑N 03 29 2026 ❑AM ❑YES ®NO U1 '< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION MFT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV ❑icy ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N O 0 FOR DAMAGED AREA(S) FRONT TOWED U1 Q Dune Isaac.C. 1 1 / yr 13-UNDER CARRIAGE ©1 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 ]$I U2 0 171 M 2 SYTM 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER O9 t6-TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 i� 6 �'.4 COM VEH 0 ix) 1 n ELGIN I L 60120 0 1 0 FIRST CONTACT 11 O7 BAR--5 *If Yes.See Sidebar U1 0 Z FS12455 IL 2026 E TELEPHONE IL D 0 KM8HACAB9TU383091 Safeway Insurance Co ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Woods. Maurice 3688572-IL-PP-004 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 MAV 0 NOV ❑DV yr Q 2 !� �1 Ti 13-UNDER CARRIAGE 10 j ©( 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-il 6 1T 4 COM VEH 0 ® U1 CO FIRST CONTACT 1 7 • -5 *If Yes.See Sidebar n ELGIN IL 60123 B 1 0 EF62924 IL 20250 So IL D 0 JTMZFREV9HJ700037 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 863033446 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DM (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 1 0 / / / UI 2 :A D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 03,29 /2026 08 15 ®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 v 2 0 2 28 03,29 ,2026 08 15 ®PM El Construction >E <w O 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM 0 Maintenance U2 o 1 ® 11 4 ARREST NAME Dungey. Isaac.C. 11-901-A S1542-000822 03/29/2026 08 20 Igi PM• ❑Utility SLMT igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM o t 2 El ARREST NAME Dungey. Isaac.C. 11-601 S1542-000820 03/29 /2026 08 49 ®PM El Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1 542 Chafe. Ethan sot 337-Thompson 04 /21 ,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 r - combination): r more than pounds(example:truck or truck/trailer 1. Has a weight rating10 000 -< INDICATE NORTH Ilon)o p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Not To Scale j - } (example:shuttle or charter bus):or 0 — — — L A I 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or CO i. i. _J.— ...1. elailgii538 ,,, L } } } C 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 __ __ -- - -- - _ __ 'ea 1� _ i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m - —`F1� .a.. ' placartling(example:placards will be displayed on the vehicle). XI"—II - CARRIER NAME Z _ __ ADDRESS 'O V) I g CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other i— --- --1 - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 White White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE DUE