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HomeMy WebLinkAbout2026-00022813 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII fll II I 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004207392 u, 1 U21 3 4 1 U1 4 U2 1 u, 1 1_12 1 U1 1 U2 1 1 11 u1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 2026I 2026-00022813 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 m® ❑ RELATED PRIVATE ®Y 0 N 04 23 2026 ❑AM YES ®NO U1 -< S RANDALL RD 1 ROUTE 20 Elgin mo /day/yr 04:05 ®PM FLOW CONDITION m ®15 ©am N E 0 Vtr S RANDALL RD I ROUTE 20 COUNTY PROPERTY ❑Y 21 N DOORING ICI #OF MOTOR 0 SLOW 15 Cn 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 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EDUCE ❑uuv ❑!Cy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) FOR DAMAGEDAREA(S) FROM TOWED U1 Q NAME(LAST,FIRST,M) Kohl. Lucas.T. 13-UNDER CARRIAGE 1a i , 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 5 r<r1 M 2 4 El ® n 15-OTHER SYSTEM❑UNK VEH. AT CRASH 99-UNKNOWN 9 76•TOP 3 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $,_iL a 4 COM VEH 0 Ea 1 0 F. FIRST CONTACT 12 7 ;—, _5 *Irves.See Sidebar U1 Z Crystal Lake IL 60014 0 1 0 EK90058 IL 2026 REAR TELEPHONE IL D 0 WBADT53403CE95257 Progressive ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 964678023 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 c x DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EWES ❑ uv 0 NCv ❑Dv '1 9 6 6 General Motorr9,�ip 2013 00-NONE +i_"' 12'-_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 101 E FIRE 0 ® u2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y Ell N 0 UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value U1 0 POINT OF s I 4 COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 7 -�I_5 •(ryes,See Sidebar C = ALGONQUIN IL 60102 0 1 0 1993138B IL 2026 PEAR Si)0 IL D 0 1 G KKVRKDODJ 147650 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 1070668-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 04(23 (2026 04 05 ®pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 o" 2 0 28 99 ( ( 0 PM• ❑Construction * N 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Kohl. Lucas.T. 11-601-Ax 489000549 / ! El PM SLMT S' N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility t 2 El AM 7 ❑❑PM 0 Unknown work zone type U1 45 ARREST NAME ( / 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 489-Reynolds.Allison 800 320-Cox 05 , 19(2026 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. r e----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 -< } } ' ' ® r INDICATE NORTH �mb natbn)or p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC Notre swb J - (example:shuttle or charter bus):or 0 I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O - E,ne mamx."wbr - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L }-----}----; ~ r t - I. } } } 4. Is used or designated to transport between 9 and 1 passen including the driver. N for direct compensation(example:large van used fors specific purpose):or L L____a____� ` i L..----• L i t 5 Is any vehd any vehiclehazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI t, CARRIER NAME Z _ ADDRESS 0I l w C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate ❑ Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Gray Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. _Other/Unknown . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE