HomeMy WebLinkAbout2026-00024091 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004222.32
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY N OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00024091 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIPINTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mDUNDEE AVE Elgin
0 0 RELATED ®Y ❑N 04 29 2026 NAM ❑YES I NO U1 —<
PRIVATE mo /day/yr 08.14 ❑PM FLOW CONDITION m
02040!MI N E O W Brandt Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
(i DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
0 6 /
yr 13-UNDER CARRIAGE 10l I!. 2 FIRE 0 N
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 n<7
F 2 4 SYTM❑Y NSNE DUNK VEH. O AT CRASH 0 15-99-UUNKNOWN THER9 76•TOP 3 `Distraction Value 9 ALGN -
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 i, a �i,4 COM VEH 0 j$J 1 0
F.
ELGIN I N I L 60120 0 1 0 FIRST CONTACT 8 O7 _; __5 *If Yes.See Sidebar U1 0
Z DP19239 IL 1026
TELEPHONE
IL D 0 SFRYD4H79HB010196 State Farm Ins ❑Y Il N U2 19 . m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 2966914-SFP-13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER XI
Refused 0 Y El 2 0
x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑NMV 0 NCV ❑DV
/2 0 0 6FROM TOWED
CIVIC 2017 00-NONE a. Q1-_, DUE TO CRASH rg D 11 x
0 13-UNDER CARRIAGE 19( I. 2 FIRE El ® U2 C
c
M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,16-TOP 3 X
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0
POINT OF 8 i1 A -4 COM VEH 0 N U1 W
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •(ryes,See Sidebar
ZCrystal Lake IL 60014 0 1 0 FF45846 IL 1026 I 0 C
Z
IL D 0 SHHFK7H21JU207338 State Farm Ins ❑Y ®N RDEF XJ
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
Aitken. Randy 3897711-SFP-13 BAC $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(!{ADDRESS)/(TELEPHONE! (EMS) (HOSPITAL)
1 6 01 / F 2 4 B 1 0
m
/ / #OCCS >
/ / UI 2 m
/ / 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 1 04,29 /2026 08 14 ®❑AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C)
v 2 0 2 23 04,29 /2026 08 14 ❑PM 0 Construction >F
R 3 ❑ El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
z J ®AM ❑Maintenance U2
o1 ® 11 1 ARREST NAME Aguirre.Claudia. I. 11-906 254001603 04,29/2026 08 19 0 PM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility
AM U, 30
r 2 ❑ ARREST NAME 04/29 /2026 09 00 o PM 0 Unknown work zone type
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y 30
254-Henke. Robert 200 331-Ziegler 06 ,09/2026 01 30 ®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
rI I 0 combination):or more thanpounds(example:truck or truckrtrarler 1. Hasaweight rating10,000 -I
ti
INDICATE NORTH p0
i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} }
1800?EbaldbfiDundw?Av� Pan' I r r (example:shuttle or charter bus):or
L A 1 I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
mn I la I - } } } transporting employees In the course of their employment(example:employee X
L L____a enger car):or co
wand e�Ave link I \ } } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and 15passengers,including the driver, C
I.401, for direct compensation(example:large van used fors specific purose):or O
L �____a____; ' I. } } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 0
SO N placarding(example:placards will be displayed on the vehicle). XI
Unrt71, -
1 I r1 CARRIER NAME Z
_♦ I _ __ ADDRESS
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I I [ . . . —
CITY/STATE/ZIP 0
MOTOR CARR.ID ❑ Interstate ❑ Intrastate
_Net To ScblbJ ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
i— --- "• - USDOT NO. ILCC NO. C
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
T.
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
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
Gray 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 DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE