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HomeMy WebLinkAbout2026-00019150 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II I 111 IIII MUH U II IlU III HflflllIU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04197772' u, 1 U21 1 1 1 U1 8 U2 1 U, 1 1_12 1 U, 1 U2 1 1 7 U1 13 U214 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El g500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00019150 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn N RANDALL RD El08:28 ® ❑ RELATED ❑Y ®N 04 08 2026 ®AM ❑YES ®NO U1 _ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n I0 ®!MI N E S W North Tall Oaks Dr Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS O 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 O Goya!,NAME(LAST,FIRST,M) y Amit mo /1 9 8 6 Tesla Y 2026 -NONE 11 12 _, DUE TO CRASH 0 EN 13-UNDER CARRIAGE 10 i 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn M 9 4 ❑Y ❑SYTHER SEDUNK VEH. 6 AT CRASH M IN ENGAGED5 99-UNKNOWN 9 le-TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s__;i L s 4 COM VEH 0 j$J 1 0 F. FIRST CONTACT 00 7 —,__5 *II sees.See Sidebar Ut Z Woodstock IL 60098 0 1 0 C4944-EL IL 2026 REAR TELEPHONE IL D 0 7SAYGDEE9TA467482 N/A ®Y ❑N U2 I— M in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Goyal.Archna N/A 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NCV 0 DV yr ( t2 2 FIRE ❑ ® U2 C o ©-UNDER CARRIAGE F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distract on Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 12 8 7 i1 II 4 COM VEH ❑ ® U1 W B '.5 •If Yes.See Sidebar — Huntley IL 60142 0 1 0 DX78729 IL 2026 I 0 N IL D 0 2HGFC3B9XGH358874 County Financial ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Deleon,Alvin, R. P003544124 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 20 1 04,08 /2026 08 28 ®❑pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 0 1 3 20 15 N 3 0 0 CITATIONS ISSUED 0 PENDING + ! _ ❑PM ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 5 —a, ARREST NAME / / ID PM ' o N 1 0 11 1 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT 50 r 2 ® 1 3 ARREST NAME AM T 1 r ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 50 471-Evans, Lakysha 602 - r ! 0 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____; I _ 1 Has eign):ht rating more than 10,000 pounds(example:truck or truckrtrailer 1. � , INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I i I 1 4 (example:shuttle or charter bus):or C mionuvor. 3. Is designed to carry15 or fewer passengers and operated a contract carrier O - LII _ - . I- . transporting employee in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.__-a-_ „ ®I�� - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C n,I for direct compensation(example:large van used for specific purpose):or L L--_-a-___- 40; L i. i i. L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires �+ placarding(example:placards will be displayed on the vehicle). XI r r 1- ''. 01 I' r r r- --1- > j t t 0 CARRIER NAME Z I ._ ADDRESS Dl , , „ „ CITY/STATE/ZIP I - i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I I i ❑ Not in Comm./Govt. 0 Not in Comm./Other O L - --4. ®ii Not rb Scrste j - . USDOT NO ILCC NO. m XI Source of above 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Blue Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 0 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE