HomeMy WebLinkAbout2026-00020578 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 IIIIII Mil 0111111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004206606
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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 ❑$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 91,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2026I 2026-00020578 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 6 71
® ❑ RELATED ®Y 0 N 04 14 2026 ®AM ❑YES ®NO U1
CONGDON AVE Elgin10:19
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m
FT l MI N E S W PRESTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0
Mao TOWED U1 Q
Miekina. Marcin.W. Freightliner CdrI45 2010 00-NONE 11 1 DUE TO CRASH ElEN E
(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE NI
101 12! FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U22 0 m
M 2 SYSTM 4 ❑Y IN NE❑UNK VEH. O ATCRASHD 0 99-U15-UNKNOWN THER O9 16•TOP 3 `Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,_:-iL 4 COM VEH 23 0 1 0
F. FIRST CONTACT 9 7 _t-_5 *II Yes.See Sidebar Ut
V Z Warrenville IL 60555 0 1 0 187658F IL 2026 REAR
TELEPHONE
IL A 7 4UZAAPDUOCAR1101 Progressive ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 BACA TRUCK&TRAILER 00440657 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER D
Refused El ® N 21 c
p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PEO 0 PEOAL 0 EWES 0 m v ❑Iry 0 Dv
!2 0 0 3 FROM TOWED
Murano 2014 00-NONE 0. Q!•-O DUE TO CRASH rg ❑ 2 73
o Yr 13-UNDER CARRIAGE 10( ) 2 FIRE ❑ ® U2 C
F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:,-4 COM VEH ❑ ® U1 W
FIRST CONTACT 12 7 _,-.5 •If Yes.See Sidebar
F= ELGINZ IL 60120 B 1 0 EH81855 IL 2026
M
IL D 0 JN8AZ1 MW4EW509676 Hugo ❑Y 123 N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire 99 9 Same HUGO-5378264 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 2 06 / M 2 3 0 1 0
m
/ / #OCCS >
/ / U1 1 m
/ / 2 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 4 04,14 l2026 10 19 ®❑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 �
v 2 ❑ 23 2 04,14 )2026 10 19 ❑PM El Construction
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R O ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ENS ARRIVED TIME 7
3 ®AM ❑Maintenance U2
o ® 11 4 ARREST NAME Miekina. Marcin.W. 11-1427.4- W1567000020 04!14 l2026 10 23 0 PM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility
AM U1 30
t 2 ❑ ARREST NAME 04 r 14 /2026 10 49 [M PM ❑Unknown work zone type
n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ ❑AM Workers present? ❑Y 30
1567 Muehl.Claudia 201 397-Jones / ❑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. as a weight rating more than 10,000 pounds(example:truck or truck trailer -<
H
r__--; r combination):or -I
Not To Scale 1 N - INDICATE NORTH p0
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
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I (example:shuttle or charter bus):or
< <---- -•-•; I transporting employeeslln5 thr e courser�o rhea emap sn bd yment exampleoemp7oyeener
} } }
transporter-usually a van type vehicle or passenger car):or03
L L____a____: m mI. 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including N
} } } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or
L �__ _a_ _ i. i _ 5. Is any vehicle used to transport anyhazardous material(HAZMA that requires
0 Unit T - - • • • placarding(example:placards will be displayed on the vehicle). m m
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D
venom CARRIER NAME BACA TRUCK&TRAILER REPAIR INC-FIRM.WN
I ADDRESS 9512 GLENLAKE AVE 129
0
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I0
CITY/STATE/ZIP ROSEMONT 1 IL 160018
a MOTOR CARR.ID 0 Interstate ❑ Intrastate .52
I r ❑ Not in Comm./Gout. 0 Not in Comm./Other
--- --1 USDOT NO. ILCC NO. m
M
Source of above z
.
Were HAZMAT placards on vehicle? 0 Yes ® No =
If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. M
M
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes ® No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes ❑ No 0 Unknown g
D
Did Carrier Safety Regulations(MCS)violation contribute to the crash? A
❑ Yes I No 0 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
Xt
IDOT PERMIT NO. WIDELOAD'; ❑Yes ®No 2
TRAILER VIM 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 ❑ ❑ 0 Z
ill
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
White Maroon
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