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HomeMy WebLinkAbout2026-00018739 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011110111110110101011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X197775 u, 1 u21 3 4 1 u, 3 Uz 1 u, 1 U21 u,99 U2 99 1 10 u1 1 u2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00018739 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ®Y 0 N 04 06 2026 ❑AM ❑YES ®NO U1 N MCLEAN BLVD Elgin01:46 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl FT l MI N E S W FOREST DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 Cl) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO U2 —I Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 Mies 0 NOV 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGED AREA(S) f'rr TOWED U1 0 Var as Coronado.Sharol.C. Honda CRV 2011 00-NONE , s 0 OUE TO CRASH ® ❑ NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 rr1 F 2 SYTM IN ENGAGED15-OTHER 5 ❑Y ®SNE❑UNK VEH. 0 AT CRASH 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, FIRST CONTACT 12 7 ;-i�6 4 COM VEH 0 0 1 0 , _5 *Irves.SeeSidebar Ut V Z Carpentersville IL 60110 B 1 0 EM69223 IL 2026 REAR 7 TELEPHONE IL D JHLRE4H79BCO29583 Integon Ins.Co. ❑Y Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 2027025324 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 NOV 0 Dv CIRCLE NUMBER(S) U1 !1 9 8 7 Ford Windstar 2000' 00-NONE O,' t2 "_, DUE TO CRASH 0 p 2 x 0mo 13-UNDER CARRIAGE 10 I z FIRE El El U2 C c F 2 6 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 ❑Y ®N El UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-it 6 11:, 4 COM VEH ❑ ® U1 W FIRST CONTACT 11 7�� _,__5 •If Yes.See Sidebar ELGIN IL 60123 B 1 0 EL70689 IL 2026 REAR 0 IL D 2FMDA5342YBB20043 Progressive ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Fedorov. Evgeniy 974446735 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 6 04 / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 04/06 /2026 01 47 ®PM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 , 2 0 25 99 , , ❑PM ❑Construction * R 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Vargas Coronado.Sharol.C. 11-305-A 327003316 / ! El PM SLMT o N ❑CITATIONS ISSUED ❑ PENDING SECTION CITATION NO. ROAD CLEARANCE TIME Utility 30 r 2 ARREST NAME AM 7 1 r ❑❑PM 0 Unknown work zone type U1 El 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 327-Hromadka.Scott 502 04 ,28,2026 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 combination):or --I < i- �__-_r_-_-; I I _ INDICATE NORTH p1 i_ i.. -:. 0 I j I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r I _ (example:shuttle or charter bus):or CL A1.....1 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X "' transporter-usually a van type vehicle or passenger car):or w L L.___a.__.J ,, -.1 - I. } I 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N I —Z- for direct compensation(example:large van used fors specific purpose):or o I I L L____a____. A >r i i _ 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires��;,i placardig(example:placards will be isplayed on the vehicle). XI '1 CARRIER NAME Z N.ZMftdan?BNd ADDRESS 0 D r r T 1 ii 1 4K. CITY/STATE/ZIP OW Not To Scale Ii. i. i. i. 4. MOTOR CARR.ID El ElIntrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other � "-——1 USDOT NO. ILCC NO. m XI Source of above z . Were HAZMAT placards on vehicle? 0 Yes 0 No q If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl XI 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 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 Blue,Light Brown u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE