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HomeMy WebLinkAbout2026-00021726 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets II III H II II IIIIII U II III III IIIIIIIIII IIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004204709- u, 9 U21 2 4 1 U1 2 U2 1 u,99 u2 1 u,99 U2 1 2 15 u, 1 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ID NOT ON SCENE(DESK REPORT) (8:1B Injury and/or Tow Due To Crash ID AMENDED YR 202612026-00021726 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 f7 N STATE ST El In05:28 ® ❑ RELATED 181 V 0 N 04 19 2026 ®AM ❑YES ®NO U1 —< _ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION Ill FT!MI N E S W FRAZIER AVE COUNTY PROPERTY ElY ® N DOORING ❑y #OF MOTOR NI SLOW 1 0)❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FRO T TOWED U1 O Unknown. ! ! Unknown Unknown 00-NONE ©, 12 , DUE TOCRASH ❑ EN NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10.I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 4 <<Tl SYSTEM IN ENGAGED 15-OTHER 916.70P 3 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = s 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,Ii_S Ii,_ 1 I• 0 9 FIRST CONTACT 11 7_: COM VEH 0 ZgJ_5 *II Yes.See Sidebar U1 0 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1) ° N/A ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same N/A 1 I `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER .5RESPOND 0 N 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 lily 0 KCV 0 Dv /1 9 6 4 Ford Focus 2017 00-NONE i1_"j Q�,-_, DUE TO CRASH rg ❑ 2 x oy Yr 13-UNDER CARRIAGE 10( ) FIRE 0 ® U2 C F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16_TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI�1:,-4 COM VEH ❑ ® U1 CO FIRST CONTACT 12 7 _, .5 •If Yes.See SidebarC H E LG I N IL 60120 0 1 0 GC72965 IL 2026aR M IL D 1 FADP3K26DL193858 First American ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same HUG05456498 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPOND 0 N u1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 05 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 9 04/19 /2026 05 28 ®❑PM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T v 2 0 2 23 / / ❑PM ❑Construction Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 —a, u ARREST NAME / / ID PM 1 ® 11 4 0 CITATIONS ISSUED ❑PENDING UtilitySLMT SECTION CITATION NO. ROAD CLEARANCE TIME o ❑ AM 45 r 2 ElARREST NAME 04/19 /2026 06 07 [M PM ElUnknown work zone type u, n T OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 1504 Real, Hilario 501 331-Ziegler / ❑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- ----_r_-_-; ® (//// } comWrtatbn)or INDICATE NORTHp1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC _ } (example:shuttle or charter bus):or 0 3. Is desgned to carry 15 or fewer passen ers and o rated a contract carrier O } } } transporting employees In the course of their empbyment(example:employee T transporter-usually a van Type vehicle or passes r car):or wL •-----}----; unit } } } •4. Is used or designated to transport between 9 and 15 asses passengers,including the driver, N for direct compensation(example:large van used fors cific purpose):or IL L____a..... e t i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires FraLer'lAve placarding(example:placards will be displayed on the vehicle). X/ CARRIER NAME Z ` l ADDRESS O 1 ` T. Not To Scele I 0 CITY/STATE/ZIP g 1 \ \ ...< 1 - i. MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- -'4 USDOT NO. ILCC NO. m XI Source of above z . • m 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 ❑ No 0 Unknown M 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 co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE