HomeMy WebLinkAbout2026-00026777 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II III HH II11II UHI UU I� III flfl UU UU1111111I1DD
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XG04231a22
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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 ❑$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00026777 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I
® ❑ RELATED ❑Y ®N 05 11 2026 ❑AM ❑YES ®NO U1
N STATE ST Elgin05:03
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
E050 !MI N E S W Tollgate Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA
® g Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 04 C)
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
Borg.Arturo 0 3 /
yr 13-UNDER CARRIAGE �a:) 2 , 2 FIRE 0
NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ❑ 0 U2 04 r<r1
M 2 SYTM 5 ❑Y ®$NE DUNK VEH. 0 AT CRASH 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ;il B 4 COM VEH 0 Ea 1 0
~ ELGIN IL 60120 C 1 0 FIRST CONTACT 12 7_: _5 *IlVes.SeeSidebar Ut
Z FB72745 IL 2026 REAR
TELEPHONE
IL D 0 SGAKRBEDOBJ358252 Kemper Insurance ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m
99 9 Sanchez.Sandra.S. 12RA000079472 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
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m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NIAV 0 KCV 0 DV
!1 9 yf 3 Toyota Tacoma 2016 00-NONE 11_"j Q�,-_, DUE TO CRASH rg ❑ 2 x
0 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C
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F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 9 0
i1 If Yes.See Sidebar U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 12 8 7 B i4 COM VEH El ®
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= Lafayette IL 47905 C 1 0 DLR908 IN 2026 REAR0 N
IN D 0 3TMCZSAN6GMO32517 State Farm ❑y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire 99 9 Same 0097048-SFP-14 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Provena St.Joseph RESPONDER
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iUNIT1 (SEAT) (DOG) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 05/11 l2026 05 03 ®AM in a Work Zone? ®N DIRP co
1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 ❑ 17 20 05/11 /2026 05 04 ®PM ❑ConstructionR 3 ❑ ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
J ❑AM ❑Maintenance U2
a ® 11 1 ARREST NAME Borg.Arturo 11-601-Ax 1561-000318 05/1 1 /2026 05 08 ®PM SLMT
j$!CITATIONS ISSUED 0 PENDING El Utility
o N SECTION CITATION NO. ROAD CLEARANCE TIME ID AM•
r 2 El ARREST NAME Borg.Arturo 11-701-A 1561-000317 05/11 /2026 05 50 0 PM ❑Unknown work zone type U1 45
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45
1561-Saroyic• Mirko 601 06 /02/2026 09 00 0 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
0 ADDITIONAL UNITS FORMS.
.. --
Not To Seale A CMV is defined as any motor vehicle used to transport passengers or property and: Z
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1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -
` ` --I -4 r_ INDICATE NORTH combination):or .Z-1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n
} } r (example:shuttle or charter bus):or 0
g m 3. Is d gned t carry 5 fewer passengers and operated a contract carrier O
- �. - } } } transporting employees In the course of thir employment(example:employee � X
It17 ?i? l�Aeat transporter-usually a van type vehicle or passenger car):or w
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_a____.l I - I. } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
for direct compensation(example:large van used for specific purpose):or
; ; ; ; ti i 'OD
a____. „ _ i. i I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
J ` placarding(example:placards will be displayed on the vehicle). ;p
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CARRIER NAME Z
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r j _ ADDRESS 0
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r CITY/STATE/ZIP 0
1 —7 i. i. i. i. MOTOR CARR.ID 0 Interstate El Intrastate
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). IDOT PERMIT NO. WIDELOADo ❑Yes 0 No =
TRAILER VIN 1 m
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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
White Silver
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Arties/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 Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE