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HomeMy WebLinkAbout2026-00019589 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III HH II11II UH UU II IlU lUU 1UUUU MMUU DDUUOO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004197852 u, 1 U21 2 4 2 U, 2 U2 1 U, 1 u2 1 U, 1 u2 1 1 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 El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00019589 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ®Y ❑N 04 10 2026 ®AM ❑YES ®NO U1 -< CONGDON AVE Elgin08:22 _ _ g PRIVATE mo /day/yr ID PM FLOW CONDITION ITl FT N E S W PRESTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT ❑V ® N WITH VEHICLES INVLD El STOPPED U2 —I ® &RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 KIN 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 1 2 FOR DAMAGED AREA(S) FROM TOWED U1 Q NAME(LAST,FIRST.M) SHAH KHAN. FARHEEN. M. mo / !1 9 r 7 Rivian R1S 2025 00-NONE „ O I_, OUETOCRASH ❑ 13-UNDER CARRIAGE 1a i , 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ® ❑ U2 2 �T1 F 2 SY4 ®Y ❑STM NE DUNK VEH. 1 AT CRASH 1 15-99-UNKNOWN 9 76•TOP 3 ,Distraction Value 5 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ;il 6 4 COM VEH 0 El 1 0 H SOUTH BARRINGTON IL 60010 0 1 0 FIRST CONTACT 12 Y _s *Irves.seesidabar Ut Z EX82239 IL 2026 E TELEPHONE IL D 0 7PDSGBBA5SN055404 STATE FARM ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m ce 99 9 SHIFA NEPHROLOGY ASS 0658527-SFP-13 2 1- 15 HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 m x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMv 0 KCv 0 Dv !2 0 0 1 BMW 335 2025 00-NONE „_., 12..-_, DUE TO CRASH rg D 2 o ©-UNDER CARRIAGE o I 2 FIRE 0 ® U2 C c M 2 6 SYSTEM IN 1 ENGAGED 1 15-OTHER 016•TOP 3 X ®Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 'i 6 l!- COM VEH ❑ ® U1 CO FIRST CONTACT 9 7 _, _s •)ryes.See Sidebar C ELGIN IL 60120 B 1 0 FB12980 IL 2026 I Si)0 z IL D 0 3MW69FT01 S8F08059 AMERICAN ❑Y ®N RDEF .xj EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Same 1010-67766-04 BAG $ 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),(A.DDRESS),(TELEPHONE) (EMS) (HOSPITAL) 1 3 11 / 2 :A / / UI D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 City of Elgin STREET SIGN 04,10 /2026 08 22 ®❑AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 2 0 150 DEXTER CT ELGIN IL 60120 2 28 04,03 ,2026 08 22 PM ❑ • ❑Construction >E R O 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ®AM ❑Maintenance U2 -a, ARREST NAME SHAH-KHAN. FARHEEN. M. 11-904-C 374001369 04,10/2026 08 30 ❑PM SLMT 0 CITATIONS ISSUED PENDING o u ® 11 4 Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑ t 2 0 34 3 ARREST NAME 04 t 10 ,2026 09 08 f PM 0 Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 374-Rizzu-o. Michael 201 05 ,05,2026 01 30 ®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 PRESTON7AVE z ____r____; 10,00000mWtionpor rating more than pound (example:truck ortruckrtrarler s INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver —I _ } (example:shuttle or charter bus):or C) Not To Scale I 3. Is designed to carry 15 or fewer passengers and operated 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 w L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----+ - •} } } g po passen rs,includi the driver, UNIT2 for direct compensation(example:large van used for specific purpose):or ___. r�rrmaHaAVE _ i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p ,00 a CARRIER NAME Z 0 ADDRESS V) C) CITY/STATE/ZIP MOTOR CARR.ID ❑ Ita ❑ I I T I ❑ Notnters in Cotemm.lGaA. Not inIntrastate Comm.lOther --- --4, USDOT NO. ILCC NO. m x Source of above z . ❑ Yes ❑ No ❑ Unknown g D Did Carrier Safety Regulations(MCS)violation contribute to the crash? El Yes Yes I 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 ❑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 ❑ 0 z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Green Silver 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE