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HomeMy WebLinkAbout2026-00016402 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110111111 0 IIIIII IIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 0420/a74.* u, 1 U21 1 1 9 U116 U2 1 U, 1 U2 1 U, 1 U2 1 1 u, 3 U2 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ®5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 7 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash ❑AMENDED YR 202612026-00016402 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SYMPHONY WAY El 12:48 SECONDARY CRASH 15 ® ❑ RELATED ❑Y ®N 03 25 2026 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m 0 !MI N E s SYMPHONY WAY-/Dou las AveCOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW Cl) © g Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD El U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 (i DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 Nuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONr TOWED U1 Q Orteon.Amanda.C. mo yr NAME(LAST,FIRST,M) 9 Kia Motors Co Iluride 2024 -NONE 11_ EN 12 `_1 OUETOCRASH ❑ 13-UNDER CARRIAGE 10 i • 2 FIRE 0NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 2 m F 2 SY4 ❑Y ❑SNEM®UNK VEH. 9 AT CRASH IN 9 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF a iI S �i COM VEH 0 j$J 4 REAR c Z ELGIN IL 60120 0 1 0 BOBO IL 2026 FIRST CONTACT 11 7_; __5 *If Yes.SeeSideDar U1 0 TELEPHONE IL D 0 5XYP5DGC8RG517626 Progressive El igiJ N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same 30963439 1 1- 5 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 ❑ DRIVER 0 PARKED 0 DRIVERLESS xi PED 0 PEDAL 0 EWES 0 NUV 0 NOV 0 DV CIRCLE NUMBER(S) U1 yr 1 0 j 12 (, 2 FIRE ❑ ❑ U2 C o 13-UNDER CARRIAGE c F 1 3 ❑Y 0 N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistractlon Value 0 - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s- l. 6 j1:, 4 COM VEH ❑ El U1 W FIRST CONTACT 00 7�� �.5 •(ryes,See Sidebar C 11'. ELGIN IL 60123 B 1 0 0 cn M IL D 0 ❑Y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 2 64 11 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER Y PO®N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 0 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 12 1 03/25 /2026 12 48 ®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 0 28 40 03,25 /2026 12 48 ®PM D Construction * <w 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME M-a, u ARREST NAME 03/25/2026 01 00 0 pm ❑Maintenance U2 1 ® 1 2 1 UtilitySLMT o SECTION CITATION NO. ROAD CLEARANCE TIME El ❑CITATIONS ISSUED PENDING r 2 ElARREST NAME 03/25 /2026 12 48 ®PM D Unknown work zone type U1 05 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? 0 Y 5 2 2 3 0 1570-Tomlin. Eli 100 397-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. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` --I -' r INDICATE NORTH combination):or -I Not To Scale 1 z—> BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C . L _ } (example:shuttle or charter bus):or -- - '-' .J 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- <_ ---- --1 - _ - }} } transporting employees In the course of their employment(example:employee � X enger i. }-----}----; (,::_ l l - } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and passengers,15r including the driver, C (,- for direct compensation(example:large van used for specific purose):or O i i 5. Is any vehicle usedtransport any hazardous materialthat (HAZMAT) requires.I. to •u placarding(example:placards will be displayed on the vehicle). ,Zmt —1 t,._,;�, CARRIER NAME Z ADDRESS 0 W C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate El Intrastate 0 1 I . 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 - USDOT NO. ILCC NO. m 73 Source of above z . GVWR/GCWR m 0 <10,0oo 0 10,000-26,000 0 >26,000 z Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 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 VIN 1 m cn 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. w Silver 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/TO: DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE