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HomeMy WebLinkAbout2026-00018557 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 M001111011111111 flil 00 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004197020` 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 ❑5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRAP/ ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ElB Injury and/or Tow Due To Crash YR 202612026-00018557 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n DUNDEE AVE Elgin 05:25 ® ❑ RELATED ®Y 0 N 04 05 2026 ❑AM YES ®NO U1 -< _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W FORD AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 -I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 O 3 / yr 13-UNDER CARRIAGE ©,I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 Ea U2 0 171 M 2 4 SYTM❑Y MS NE ❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iL 6 1, 4 COM VEH 0 Ea 0 f. FIRST CONTACT 11 7_:—__;__5 *lives.See Sidebar U1 . Z Chicago IL 60637 0 1 0 AL30289 IL 2026 REAR TELEPHONE IL D 0 JTEBU5JR9J5569968 Progressive ❑v IlN U2 1- in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 992237309 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 ou N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 2 0 0 4 General Motor-WETpl 2012 00-NONE 1("j 12--_, DUETOCRASH ❑ I1 2 x o y Yr 13-UNDER CARRIAGE 10'I c. 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y 23 N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s .i�._.4 COM VEH ❑ ® U1 CO FIRST CONTACT 7 7 -`-�•(ryes,See Sidebar C ELGIN IL 60120 0 1 0 FW54585 IL 2026 I 0 fp IL D 0 2G KFLXE52C6349840 American Alliance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same I LAA-0971538-01 BAc $ 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(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 6 11 / F 12 4 0 1 0 m / / #OCCS D / / UI 2 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 11 4 41 /12 /26 05 25 ®pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP H . AM U1 o" 2 0 28 99 / / ❑PM• ❑Construction Z3 0 lyg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 5 a1 ® 11 4 ARREST NAME George. Marcus. D. 11-601 1530000665 / / El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility T 2 ❑ ARREST NAME AM 7 / / pM El Unknown work zone type 15 U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 15 1530-Soto.Oscar 102 51 / 12 /26 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. Dundee?Ave r ----r----, , . A CMV is defined as any motor vehicle used to transport passengers or property and: Z ` ` ''- -' I I INDICATE NORTH 1.�mWrtatron)Has a gor ht rating more than 10,000 pounds{example:truck or truck/trailer -< +— i r N 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 Ilds 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O ` ` -A- - Not To Scale es pa g pe } } } transporting employees In the course of their employment(example:employee � � i'� i transporter-usually a van type vehicle or passenger car):orCO L L.___a____� I I } } } •4. Is used or designated to transport between 9 and 1passengers,includingthedriver, N for direct compensation(example:large van used fors cific purose):or L -a-___� - � i I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -u Unit 2 placarding(example:placards will be isplayed on the vehicle). m Ford?Ave > CARRIER NAME Z ADDRESS 0 O CITY/STATE/ZIP C) MOTOR CARR.ID 0 Interstate 0 Intrastate 5 ' I ❑ Not in Comm./Govt. Not in Comm./Other ;_...Y. ._ I I USDOT NO. ILCC NO. m r . . . . ...- 73 Source of above z . 0 Yes 0 No ❑ Unknown A 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 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. 0 Black Black 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