HomeMy WebLinkAbout2026-00025787 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets MI1111111111111
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 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 15
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00025787 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 7 '1
® ❑ RELATED PRIVATE ®Y 0 N 05 06 2026 ❑AM ❑YES ®NO U1 -<
RT201 HIGHLAND WOODS BLVD Elgin mo /day/yr 06:54 ®PM FLOW CONDITION m
®75 ®!MI N E 0 W RTZO/HIGHLAND WOODS BLVD COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 cn
Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
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 1 0
FRONT TOWED U1 0
NAME(LAST,FIRST,M) Malkinski. Piotr.G. mo Volvo VNL 2000 00-NONE „_ O'i_, DUE ToCRASH ❑
EN
13-UNDER CARRIAGE 10 i : 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 1 M
M 2 SYTM IN ENGAGE15-OTHER
4 ❑Y ®SNE❑UNK VEH. 1 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF II 6 4-5 *IIYes.See Sidebar Ut COM VEH 0 Ea 1
0
F FIRST CONTACT 12 7_7 _
Z South Elgin I L 60177 0 1 0 831 XAW CO 2027 r' ,
TELEPHONE
IL A 7 4V4ND4RJ3YN782102 Northland Insurance Compa ❑v ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Red Mustang Transpor WN415013 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
20
x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0
1 9 6 0 Jeep(after 196g)ind Cherokee 2024 00-NONE ,,_"j t2..-_, DUETO CRASH ❑ ! l 2 x
o 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3
❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 4
POINT OF 8 I 4 COM VEH ❑ ® u1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6
FIRST CONTACT 6 7 -�I_5 •(ryes,See Sidebar C
Batavia IL 60510 0 1 0 JJ D202 IL 2026 " 4 fn
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IL D 0 1C4RJKEG8R8505837 Owners Insurance Company ❑Y ®N RDEF 71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same 5431435901 BAG $
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)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 05,06 ,2026 06 54 ®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)
0 2 ❑ 03 28 ) / ❑PM ❑Construction *
4
r' 3 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME
❑AM ❑Maintenance U2
o ® 11 1 ARREST NAME Malkinski. Piotr.G. 11-601-Ax W1525001011 t r El PM SLMT
o N 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility
0 AM
r 2 ❑ ARREST NAME 051 06 12026 07 42 ®PM El Unknown work zone type U1 5O
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
❑Y 50
1525-NavE.Oscar 901 393-Gutierrez , , ❑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- }-----I-----1 I Not To Scale } INDICATE NORTH combination):or
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n
/ - } (example:shuttle or charter bus):or
I3. Is designed to carry15 or fewer passengers and operated a contract carrier O
I - } } } transporting employee in the course of their employment(example:employee73
transporter-usually a van type vehicle or passenger car):or w
L }-----}----; /---.� _ _ - , } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N
°` -.Z77 _ for direct compensation(example:large van used for specific purpose):or O
L L____a____. �- ,v'.= (gta,` _ � 1 L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
,.lnZ placarding(example:placards will be isplayed on the vehicle). ;p
_ 2).
\ CARRIER NAME
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\ _ __ ADDRESS
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N X N Z
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CITY/STATE/ZIP g
N \ N - i. i. i. i. MOTOR CARR.ID 0 Interstate ❑ Intrastate
I I T I N \ ❑ Not in Comm./Govt. 0 Not in Comm./Other 00
---------'4 - USDOT NO. ILCC NO. rn
73
Source of above z
. own tank)? 0 Yes 0 No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown g
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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
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LOCAL USE ONLY TRAILER VIN 2 m
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TRAILER WIDTH(S) 0-96" 97-102" >102' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
White White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 TOWED BY/TO:
_ . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE