HomeMy WebLinkAbout2026-00024197 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Dt 6 Sheets 01111101111 10110 ll 111111111 lU 10111100
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004222729
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash
0 AMENDED YR 2026I 2026-00024197 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED PRIVATE ❑Y ®N 04 29 2026 ❑AM ®YES 0 NO U1 -<
N RANDALL RD Elgin mo /day/yr 03:56 ®PM FLOW CONDITION m
I 0 ®!MI N E 0 VY POINT Blvd COUNTY PROPERTY ❑Y ® N G ❑y #OF MOTOR 0 SLOW 1 Cl)
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
gi DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NOV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Tchintchinov. Elzbieta 0 mo 1 /
13-UNDER CARRIAGE 10 : 2 FIRE 0 N
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 rn
F 2 4 ❑Y ®N SYSTEM
❑UNK VEH. AT CRASHD 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR
F. POINT OF $ ;iI 8 4 COM VEH 0 0 1 0
FIRST CONTACT 12 7 . _5 *If Yes.See Sidebar U1
Z Crystal Lake IL 60014 B 1 0 DC61538 IL 2026 I ,
TELEPHONE
IL D 0 SLMCJ1C92KUL10097 StateFarm ❑Y ISIN U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Tchintchinov. Dimitre.G. 3615307SFP13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER >
Refused ❑Y ® N 2 XI
g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑
y Yr 2 0 0 3 Toyota Corolla 2026 00-NONE 11_"j Q�,-_, DUE TO CRASH rg ❑ 2 x
o 13-UNDER CARRIAGE 1U) I.. 2 FIRE 0 N U2 C
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistrac) n Value 9
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 5
FIRST CONTACT 6 7I- 4 COM VEH ❑ N u1 CO
•IfYes.See Sidebar C
Bartlett IL 60103 0 1 0 2180232 IL 2026 PEAR 0 Si)
IL D 0 7M U DAABG7TV152797 Progressive ❑Y ®N RDEF ZI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
99 9 Sztaba Filimon. Kamila 964587751 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)
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71
/ U1 1 m
1 0
E/ 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 03 56 ®pm in a Work Zone? NCI 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 �
o"
2 0 28 99 + ) 0 PM• ❑Construction *
1
N 3 0 N CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM 0 Maintenance U2
o ® 11 1 ARREST NAME Tchintchinov. Elzbieta 11-601 1530000712 , r El PM SLMT
o N
❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility
r 2 ❑ ARREST NAMEAM
c- T 1 / ❑❑PM 0 Unknown work zone type 45
U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45
1530-Soto.Oscar 983 06 ,02,2026 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 -- 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 -<
i- }----{-----; Not To Scale 1 - } INDICATE NORTH combination):or -I
i IUnIt t 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
— - } (example:shuttle or charter bus):or
i r X
1 r I r7l 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O
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} } 1. transporting employees In the course of their employment(example:employee
IN '
transporter-usually a van type vehicle or passenger car):or at
L i. __I.,.. ...I. .e i - •} } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver, y
NO for direct compensation(example:large van used for specific purpose):or O
L L____a.....: ,-, t i i L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
C .
� placarding(example:placards will be displayed on the vehicle). D
J • - , -- CARRIER NAME
ADDRESS 'Z
'I��1 i D
j !...L..._r to
Ir CITY/STATE/ZIP 0
uS r L' - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
tom' ❑ Not in Comm./Govt. ❑ Not in Comm./Other
1 1 1 1
, I USDOT NO. ILCC NO m N?Randall?Rd xi
m
Source of above z
. MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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
Black Black
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE