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HomeMy WebLinkAbout2026-00027825 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II I 111 IIII UHI U I� III flfl 1lifliIOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004234-495 u, 1 U21 2 4 1 U, 4 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00027825 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :l ST CHARLES ST Elgin03:47 ® ❑ RELATED ®Y 0 N 05 16 2026 ❑AM ❑YES El NO U1 -< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT!MI N E S W DWIGHT ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 1 (n ❑ Kane HIT ❑Y ® N WITH VEHICLES INVLD El STOPPED U2 --I El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n f4T TOWED U1 FOR DAMAGEDAREA(S) FRO 0Phamanivon Phoutsalhone 0 9 / yr 13-UNDER CARRIAGE ©it),I 0,:0 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 2 m F 2 SY8 ❑Y ❑STM NE®UNK VEH. 9 ATCRASHD 9 99-U 15-UNKNOWN 916•TOP3 `Distraction Value 9 ALGN X. V. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & it 6 4 COM VEH 0 j$J 1 0 H F. BARTLETT IL 60103 B 1 0 FIRST CONTACT 12 7_: __S *II Yes.See Sidebar u1 ZZX35074 IL 2026 REAR TELEPHONE IL D 4T1 BF1 FK3GU267170 Geico ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Elgin Fire Porter. Landon 4195-06-41-28 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 XI m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 l uv 0 Ncv ❑Dv Yr!1 9 5 3 Kia Motors Col�orento 2017. 00-NONE „ �j-_, DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE 1, FIRE 0 El U2 U2 Ti F 2 8 SYSTEM IN 9 ENGAGED 9 15-OTHER O9 16-TOP 3 X ❑Y ❑N ®LINK VEH. AT CRASH 99-UNKNOWN *Dist/neon Value 9 0 POINT OF 8 I 4 COM VEH 0 ® ut IN N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1:-_ C FIRST CONTACT 11 7 , _5 *(ryes.See Sidebar North Aurora IL 60542 B 1 0 KEITH9 IL 2026 TEAR 0 Si) IL D 5XYPG4A35HG316638 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 1515185-SFP-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) 0)0BI (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 Zavala. Lizeth House Damage 51 ,61 ,026 03 47 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 0 763 ST CHARLES ST ELG I N IL 60120 23 99 51 ,61 ,026 03 47 MA 1 ® • ❑Construction * R 3 0igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Phamanivong. Phoutsalhone 11-1204-B S1552000355 51 ,61 ,026 03 53 ®pm SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility t 2 El ARREST NAME 51 +61 1026 04 53 ®PM 0 Unknown work zone type U1 0 AM 35 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1552-Thompson.Ahmad Rashad 401 337-Thompson 61 , 61 ,026 01 30 ®PM Workers present? ®N U2 35 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. Hasa weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }__-_r_-_-; I comWnatbn)or INDICATE NORTH -1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver I i - } (example:shuttle or charter bus):or 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- <.__-A-.-.� —� I r� _ ; } } } transportingemployees In the course of their g employment(example:employee transporter-usually a van type vehicle or passenger car):or co L L.___a.._.� i`i 4. Is used ordesi natedtotrans rt between 9 and 15passengers,includingthedriver, C Imo r__ N } } } • for direct compensation(example:large van used for speific purose):or 0 Mt. � l. I 1 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z t 6 977 OYiIg""a 0ADDRESS 0Not To Scale 1 I 0 ,O„„p1N1M7Bt CITY/STATE/ZIP MOTOR CARR.ID El Interstate El Intrastate snawree7s n I r s ❑ Not in Comm./Govt. 0 Not in Comm./Other --- '-1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown 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 White Beige 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