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HomeMy WebLinkAbout2026-00028991 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111 III 11 III1II IIIIII U II III flfl II H 1111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004235647' u, 1 U21 3 4 1 u, 8 U2 1 u, 1 1_12 1 u, 1 U2 1 1 12 u, 13 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00028991 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED PRIVATE ®Y 0 N 05 21 2026 ❑AM ❑YES ®NO U1 KI M BALL ST Elgin mo /day/yr 02:50 ®PM FLOW CONDITION Ill _ ®75 ®!MI N OE S W Center St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 Mlles 0 WIN 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) FOR DAMAGEDAREA(S) FROr'tf TOWED U1 0Beltran Rodriguez, Nelson 0 8 1 yr 13-UNDER CARRIAGE ©,I 0• ,:0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 23 U2 NI 2 m M 2 4 ❑Y ®N SYSTEM ❑UNK VEH. O AT CRASH D O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�s �i 4 COM VEH 0 El 1 0 ~ ELGIN IL 60123 0 1 0 FIRST CONTACT 1 7 ; __5 *IIYes.SeeSidebar U1 Z EQ38242 IL 2026 REAR TELEPHONE IL D 0 State Farm ❑Y Il N U2 1- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 2697050-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y 23N 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PEO 0 PEDAL 0 EWES 0 NMV 0 NCv 0 DV Yr 2 0 0 4 Honda Accord 2012 00-NONE al t2 ! 2 FIREo CRASH ® U2 2 C o 13-UNDER CARRIAGE c ij F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y gi N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 U1 0 POINT OF 8 i1�. 4 COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 1 O 7 B .5 •If Yes.See Sidebar C Z Gilberts IL 60136 0 1 0 FZ89481 IL 2027 I 0 D IL D 0 1 HGCP2F63CA131858 West Bend ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Patel, Krima, D. H H D 6574893 11 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) 2 3 05 / F 2 4 0 1 0 m / / #OCCS D / / U1 1 D / / 2 0 EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 5/ , 1/ ,026 02 50 ®PM 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 2 0 11 1 28 20 N 3 0 CITATIONS ISSUED 0 PENDING + ) ❑PM• ❑Construction >F SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 —a, ARREST NAME / / El PM ' 1 ® 1 1 1UtilitySIMT o N SECTION CITATION NO. ROAD CLEARANCE TIME 0 ❑CITATIONS ISSUED PENDING 0 AM t 2 ElARREST NAME 5/ t 1/ /026 02 52 ®PM ElUnknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1 542 Chafe. Ethan 101 337-Thompson 61 , 61 ,026 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 combination)or rating more than 10,000pound (example:truck or truck/trailer i- -----I-----; ® Not To Scale I - INDICATE NORTH -I p1 ii.ii•i 1Plil BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ (example:shuttle or charter bus):or 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O I- <.__-A----I , ,.`), - . } } } transportingemployees in the course of their employment # ' (example:employee S_-1 _ transporter-usually a van type vehicle or passenger car):or 03 < <.___a.._.� 1 Ii - iii _ 1* } } 1" •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (I)for direct compensation(example:large van used for specific purpose):or L i.--_-a. 7- - - 4, L 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m , t placarding(example:placards will be displayed on the vehicle). —1 0 CARRIER NAME Z XI 3 _ -- ADDRESS 'n ' CITY/STATE/ZIP ri MOTOR CARR.ID 0 Interstate ❑ Intrastate 0 r ❑ Not in Comm./Govt. Not in Comm./Other ;____Y_._.; - USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Purple 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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE