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HomeMy WebLinkAbout2026-00022325 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I0110 II III I II IIIII�IIII IIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00�4207 0 u1 9 U21 1 1 1 U1 5 U2 1 U1 1 U2 1 U1 1 U2 1 5 10 U, 4 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00022325 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I E CHICAGO ST El In 09:10 ® ❑ RELATED ®Y 0 N 04 21 2026 ❑AM ❑YES ®NO U1 —< _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W WALKER PL COUNTY PROPERTY El ® N DOORING Ely #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑ncv ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 C) FOR DAMAGEDAREA(S) FRO T TOWED U1 O NAME(LAST,FIRST,M) mo !1 9 8 0 Ford F150 2005 00-NONE „ 12 , DUE TO CRASH 0 VIE 13-UNDER CARRIAGE ) I FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 !O DISTRACTED 0 0 U2 99 I'T1 M 2 4 SYTM❑Y ®SNE❑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 s 1B �i 4 COM VEH 0 0 1 0 ~ ELGIN N I L 60120 0 1 0 FIRST CONTACT 2 7_;- -_5 *IrYes.See Sidebar U1 Z 2998994B IL 2021 TELEPHONE IL D 0 1 FTPX145X5FB43306 NONE ❑Y 0 N U2 I''I in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Unknown NONE 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER . Refused 0 Y°®N 0 L g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES O NIAV 0 i v ❑Dv !2 0 0 0 Toyota Camry 2007 00-NONE O 2 "O DUE TO CRASH ❑ 2 0 Yr 13-UNDER CARRIAGE 9 I ©1. 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracl on Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF i1i" 4 COM VEH ❑ ® U1 CO6 FIRST CONTACT 11 8 7 _5 •If Yes.See Sidebar — Lanham Seabrook MD 20706 0 1 0 FS59490 IL REAR 0 MD D 0 4T1BE46K87U523467 Magnum ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Grace. Marshana. M. ILAA108969800 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 04 / F 2 3 0 1 0 m / / #OCCS D / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 04 121 /2026 09 10 ®pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 06 99 N 3 0 ❑CITATIONS ISSUED 0 PENDING • + ! ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 —a, ARREST NAME / / El PM ' o N 1 ® 11 4 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 30 r 2 ARREST NAME AM 7 1 r O PM El Unknown work zone type U1 El OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 1569 Jaimes.Julian 301 320-Cox r ! ❑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 -< c ` -' -' r INDICATE NORTH combination):or —I i L .4. N 1BYARROW 2 Isusedordesi nedtotran ortmorethan15 C g transport passengers including the driver J (example:shuttle or charter bus):or U 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 E4CMaw7et - • } } } transporting employees In the course of their employment(example:employee X tali_ __■ i transporter-usually a van type vehicle or passenger car):or w L }-----}----+ �ill� ��o - } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver, ' - - - for direct compensation(example:large van used for specific purpose):or % 1'4.. O __ _ } } } _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m — — — — - — placarding(example:placards will be displayed on the vehicle). XI —1 — — — — — — — CARRIER NAME Z ADDRESS 0 Not To Scale j CITY/STATE/ZIP o MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 USDOT NO. ILCC NO. m XI Source of above z . Did Carrier Safety Regulations Yes IQ N)o El violation own to the crash? A 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE