Loading...
HomeMy WebLinkAbout2026-00018933 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 ll 1111011111111010 0000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X197778 u, 1 U21 3 4 1 U, 4 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U211 *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 El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00018933 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mROUTE 20 HWY Elgin ® ❑ RELATED ❑Y ®N 04 07 2026 ®AM ❑YES ® PRIVATE NO U1 mo /day/yr 08.51 ❑PM FLOW CONDITION m _ ®20 ®/MI N E S © Randall Rd COUNTY PROPERTY ❑Y ® N DOORING ICI #OF MOTOR ElSLOW 15 Co 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 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NOV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q NAME(LAST,FIRST,M) Kerwin, Paul,A. mo 0 9 / /1 9 8 4 Mazda CX-90 2025 00-NONE 11 OI_1 DUE TOCRASH ❑ EN 13-UNDER CARRIAGE 10 ' 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 14 U2 2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76-TOP 3 _ CI N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 :il 6 4 COM VEH 0 ZgJ 2 O ~ ELGIN N I L 60124 0 1 0 FIRST CONTACT 12 7_; _5 *II Yes.See&debar U1 Z FR18755 IL 2026 E TELEPHONE IL D JM3KKBHD3S1253923 GEICO ❑Y ®N U2 M 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 6070067472 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 73 m x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 IIIAV 0 NOV 0 DV 0 0 7 FR Acura RDX 2014 00-NONE 1.11 t2..-_, DUETO CRASH 0 !1 2 x omy Yr 13-UNDERCARRIAGE tal 2 FIRE ID ® U2 C c F 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac 3 on Value U1 POINT OF 8 i 4 COM VEH D ® co N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR .II 5 �'_ FIRST CONTACT 6 Y__{_O -_5 •IfYes.SeeSidebar 1= PINGREE GROVEZ IL 60140 0 1 0 DY52105 IL 2027aR IL D 5J8TB4H5XEL008354 State Farm ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 3364304SFP13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 11 1 4/ 1/2 /26 08 51 ❑PM in a Work Zone? ®N DIRP D co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 28 99 + / ❑PM- ❑Construction * 1 R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 op 1 ® 11 1 ARREST NAME Kerwin, Paul,A. 11-601 289001370W / / El PM SLMT o N • 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility r 2 El NAME AM T 1 1 ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 30 298-Lopez, Mirko 801 - r 1 ❑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 -< ` ` --I -' INDICATE NORTH combination):or .Z-1 BYARROW 2 Is used ordesi nedtotran transport C g sp passengers including the driver } r r r (example:shuttle or charter bus):or 0 A 0 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 0 } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w ttovtarracmiwy L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O Nat D L L____a____. TO�°1° t l. L I _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires rn placarding(example:placards will be displayed on the vehicle). D • • '�rtia�y CARRIER NAME 3 ADDRESS _ T.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 . 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 71 IDOT PERMIT NO. WIDELOAD'; 0 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 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' 2 TOWED BY/TO: _ 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